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 PHYSICIANS ADA JOB ACCOMMODATION REQUEST DISABILITY VERIFICATION FORM 2019

2019-2025 Form

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Instructions and help about PHYSICIANS ADA JOB ACCOMMODATION REQUEST DISABILITY VERIFICATION FORM

jan job accommodation network practical solutions workplace success 800-526-7234 for voice 877-781-9403 for tty askjan.org a disability to obtain an accommodation jackie is a nurse at a hospital she reveals to her supervisor tom that she has multiple sclerosis and requests an accommodation jackie enters tom's office and then sits adjacent to him come in thank you for seeing me tom oh take a seat what's up jackie well there's something i need to talk to you about it's personal okay shoot i haven't mentioned this before but i have ms um multiple sclerosis and lately i've been having more flare-ups ms flare-ups okay got it and well when these flare-ups occur i experience quite a bit of fatigue appearing sometimes tom shuffles paperwork the rotational shifts that i'm on it makes it difficult to regulate my meds and get enough sleep i see and well i i'm concerned how the fatigue and difficulty concentrating may affect my focus

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