№ lp_2_1_09519
File format: docx
Character count: 2327
File size: 21 KB
Medical release authorization form permitting disclosure of job-related health information, excluding genetic data, for the purpose of determining disability status and workplace accommodations under the Americans with Disabilities Act.
Document Type:
Medical Information Release Authorization Form
Legal Basis:
Americans with Disabilities Act (ADA)
Subject:
Disclosure of Medical Information for Reasonable Accommodation
Involved Parties:
Patient; Health Care Provider; Agency ADA Coordinator or Designee
Purpose:
Determination of Disability Status and Workplace Accommodations
Confidentiality:
Information to Remain Confidential Under Applicable Law
Exclusions:
Genetic Information Not Authorized for Disclosure
Validity Period:
One Year from Date of Signature or Until Written Withdrawal
Signature Requirement:
Patient Signature and Date Required
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Note:
Year
Topic:
Educational Support Strategies
Document Type:
Instructional Support Guidelines
Year:
2020
Region / City:
Calgary
Theme:
Education, Graduate Studies, Remote Participation, Examination
Document Type:
Policy
Organization / Institution:
University of Calgary, Faculty of Graduate Studies (FGS)
Author:
Faculty of Graduate Studies
Target Audience:
Graduate students, Faculty of Graduate Studies, Supervisors, Examiners
Effective Period:
March 12, 2020 - until further notice
Approval Date:
March 12, 2020
Date of Changes:
N/A
Guidelines:
Temporary regulations for scheduling oral thesis and candidacy exams
Context:
Document provides temporary guidelines for conducting remote oral thesis and candidacy examinations due to COVID-19 restrictions.
Year:
2020
Region / City:
Bar Harbor
Topic:
Employee Housing
Document Type:
Report
Organization / Institution:
Town of Bar Harbor
Author:
Planning and Code Department
Target Audience:
Town Council, Planning Board, residents of Bar Harbor, business owners
Period of Validity:
Ongoing
Approval Date:
January 9, 2020
Date of Amendments:
January 8, 2020 (Public Hearings)
Year:
N/A
Region / City:
Lancaster County, Pennsylvania
Topic:
Disabilities, Court Services
Document Type:
FAQ
Organization / Institution:
Lancaster County Court
Author:
N/A
Target Audience:
Individuals with disabilities seeking accommodation in court proceedings
Period of Action:
N/A
Approval Date:
N/A
Date of Amendments:
N/A
Year:
2023
Region / City:
Lancaster County, PA
Topic:
Disability accommodations
Document type:
Policy Statement
Author:
Lancaster County Government
Target audience:
Qualified individuals with disabilities, legal professionals, County staff
Period of validity:
Ongoing
Approval date:
Not specified
Date of last change:
Not specified
Context:
This document outlines the procedures and policies for requesting reasonable accommodations for individuals with disabilities to participate in County and court services, programs, and activities in Lancaster County.
Year:
2026
Region / City:
Iowa State University
Subject:
Academic accommodations for students with disabilities
Document Type:
Student guide
Institution:
Iowa State University
Author:
Student Accessibility Services
Target Audience:
Students with disabilities
Period of Validity:
2026 academic year
Approval Date:
2026
Modification Date:
Not specified
Year:
2023
Region / City:
Los Angeles County
Topic:
Pre-employment accommodations
Document type:
Instruction form
Organization / Institution:
Los Angeles County Department of Human Resources
Author:
Los Angeles County Department of Human Resources
Target audience:
Job applicants in Los Angeles County
Period of validity:
Until further notice
Approval date:
Not specified
Date of changes:
Not specified
Year:
2024
Region:
South Dakota, United States
Document type:
Guidelines
Issuing body:
South Dakota Department of Education
Assessment system:
South Dakota state assessments
Subject areas:
English Language Arts, Mathematics, Science
Target population:
Students in grades 3–8 and 11
Intended audience:
School-level personnel, assessment staff, administrators, IEP and Section 504 teams
Legal framework:
Every Student Succeeds Act (2016); Individuals with Disabilities Education Improvement Act (2004); Section 504 of the Rehabilitation Act of 1973
Assessment consortium:
Smarter Balanced Assessment Consortium
Publication date:
June 2024
Source type:
Official educational policy and guidance document
Note:
Year
Topic:
ADA accommodations
Document Type:
Form
Organization / Institution:
Oregon Judicial Department
Target Audience:
Individuals requesting ADA accommodations
Contextual Description:
A form for requesting ADA accommodations from the Oregon Judicial Department, detailing necessary contact information, types of accommodations, and procedures for submission.
Year:
2023
Region / City:
Gahanna, OH, Columbus, OH
Topic:
Directions, Accommodation, Catering, Event Logistics
Document Type:
Instructional/Informational
Organization:
Not specified
Author:
Not specified
Target Audience:
Visitors to the Training Center
Effective Period:
Not specified
Approval Date:
Not specified
Date of Changes:
Not specified
Year:
2023
Region / City:
Fayetteville, AR
Topic:
Pregnancy-related accommodations in education
Document Type:
Policy
Institution:
University of Arkansas
Author:
Title IX Office
Target Audience:
Students of the University of Arkansas
Period of Application:
Ongoing
Approval Date:
Not specified
Amendment Date:
Not specified
Context:
The document outlines the process and provisions for students requesting reasonable accommodations based on pregnancy, childbirth, or related medical conditions at the University of Arkansas, in accordance with Title IX regulations.
Year:
2020
Region / City:
Maryland
Topic:
Disability and Health
Document Type:
Toolkit
Organization / Institution:
Maryland Department of Health, Center for Chronic Disease Prevention and Control
Author:
Maryland Department of Health
Target Audience:
Public health professionals, healthcare providers
Effective Period:
2016–2021
Approval Date:
2016
Amendment Date:
N/A
Note:
Year
Contextual Description:
A formal document requesting accommodations for the QABA Credentialing Board Examination based on a specific learning or physical disability.
Year:
2021
Region / City:
Monroe, Louisiana
Subject:
Special Accommodations for Students with Disabilities
Document Type:
Handbook
Institution:
University of Louisiana Monroe
Author:
Karen Foster, M.Ed., LPC-S; Kim Storm, M.S., LPC-S
Target Audience:
ULM Students with Disabilities
Period of Validity:
Ongoing
Approval Date:
Not specified
Date of Changes:
Not specified
Year:
2019-2020
Region / City:
Tri-Cities, Washington
Topic:
Academic Integrity, Student Services, Campus Safety
Document Type:
Syllabus Supplement
Organization / Institution:
Washington State University
Author:
Unknown
Target Audience:
Students at Washington State University, Tri-Cities
Period of Validity:
Academic year 2019-2020
Approval Date:
September 4, 2019
Modification Date:
Not specified
Year:
2023
Region / City:
Oregon
Topic:
Accessibility, ADA compliance, curb ramp design
Document Type:
User Guide
Organization / Institution:
ODOT
Author:
ODOT
Target Audience:
Designers, engineers, and contractors working on ADA curb ramp projects
Effective Date:
January 2023
Date of Approval:
January 2023
Training Required:
Yes, for ADA curb ramp design exception request form
Relevant Regulations:
ADA, ODOT Highway Design Manual
Supporting Documents:
ADA Curb Ramp Design Exception Template
Method of Submission:
Email to [email protected]
Employee/Applicant Request for Americans with Disabilities Act (“ADA”) Reasonable Accommodation Form
Note:
Year
Topic:
Disability Accommodation
Document Type:
Form
Organization / Institution:
[AGENCY NAME]
Target Audience:
Employees / Applicants
Contextual Description:
Form for requesting reasonable accommodation under the ADA and MHRA for employees or applicants with disabilities.
Year:
1990
Region / city:
United States
Theme:
Disability Rights
Document Type:
Legislation
Authority / Organization:
U.S. Department of Justice
Author:
U.S. Government
Target Audience:
General public, individuals with disabilities, service providers
Period of Action:
Ongoing
Date of Approval:
July 26, 1990
Date of Amendments:
2008
Note:
Contextual Description
Year:
N/A
Region / City:
Lancaster County, Pennsylvania
Topic:
Disabilities, Court Services
Document Type:
FAQ
Organization / Institution:
Lancaster County Court
Author:
N/A
Target Audience:
Individuals with disabilities seeking accommodation in court proceedings
Period of Action:
N/A
Approval Date:
N/A
Date of Amendments:
N/A
Year:
2024
Region / City:
Wisconsin
Topic:
Accessibility, Accommodation Requests
Document Type:
Form
Agency / Organization:
Wisconsin Department of Transportation
Author:
Taqwanya Smith, Senior Title VI and ADA Coordinator
Target Audience:
Individuals requiring accommodation for department programs, services, activities, or meetings
Effective Period:
Not specified
Approval Date:
Not specified
Modification Date:
Not specified