RE John (XXXXXX) XXXXXXX, Age 18, DOB XXXX1986

www.hrtw.org Sample Letter to Document Disability From Primary Care Physician

To Vocational Rehabilitation

Date

TO: NAME OF VR COUNSELOR

Office of Rehabilitation Services

ADDRESS

CITY, STATE

FROM: DOCTOR’s NAME (its better if this is on the physician’s letterhead)

RE: John (XXXXXX) XXXXXXX, Age 18, DOB XX/XX/1986

Phone: XXX-XXX-XXXX

Graduate of XXXXXX High School as of June 9, 2004

Dear NAME OF VR COUNSELOR,

The purpose of this letter is to document significant chronic health conditions that impair activities of daily living for XXXXXXX – XXXXXX. I have been his primary care physician for18 years.

XXXXXX’s health issues and their effect on school and potential employment do meet the definition of disability by Utah’s Vocational Rehabilitation criteria [Title 53A Chapter 24, 102(3)] and ADA and Section 504 requirements (see fact sheet on last page).

SIGNIFICANT HEALTH IMPAIRMENTS

• Endocrine System - TYPE ONE DIABETES

• Digestive System - ULCERATIVE COLITIS

• Immune System - ANKYLOSING SPONDYLITIS

CONFIDENTIALITY SAFEGUARDS - In compliance with HIPAA confidentiality mandates permission for this personal health information has been obtained by the patient, and as such this letter should be treated as highly confidential records and not shared without the patient’s permission.

What follows is an overview of the health issues that XXXXXX lives with. Enclosed are relevant reports and findings of recent and past health related medical testing.

TRAINING FOR EMPLOYMENT & IMPORTANT OF HEALTH CARE BENEFITS

It is important to consider what XXXXXX could do to meet his potential, live independently, and remain as healthy as possible. XXXXXX is a very bright young man who has displayed numerous talents in music, art, writing, literature, and science.

Given his educational performance, intellectual abilities and aspirations, he certainly has the potential to do well in competitive employment through post-secondary college courses – if supported. It will be essential that career development be aimed at stable; well-paying jobs that offer comprehensive benefits to assure maintain health status and financial independence.

In sum, I believe that offering XXXXXX financial and technology support through the Office of Rehabilitative Services would ensure not only employability but also would support all important aspects of independent living and optimal quality of life. Please contact me if you require further information.

Sincerely,

XXXXXXXXX, M.D.

Etc.

相关推荐
相关主题
热门推荐