Request for Medical Documentation
Generally, an employee’s medical condition is not the agency’s interest, unless it affects the employee’s conduct or ability to perform their job. In some instances, however, a supervisor may: (1) suspect an employee has a medical condition that may be impacting their ability to report to work and/or perform his/her full range of duties; (2) be notified by an employee that a medical condition is impacting his/her attendance, performance, or conduct; or (3) receive an oral or written request from an employee, their health professional, or other representative, for restrictions on the employee’s duties or for an accommodation ( please note, the employee does not need to use the phrase “reasonable accommodation” or “accommodation”; see the NIH Policy Manual 2204 on Reasonable Accommodations.
On occasion, a manager may need to request medical documentation from the employee to determine whether to grant extended leave or to implement an accommodation. Such requests must be in compliance with EEOC Enforcement Guidance and guidance from the Office of Personnel Management (OPM). It is the employee’s responsibility, however, to submit sufficient medical information to support any requested accommodation. Further, the employee’s failure to provide adequate medical documentation could result in the denial of the request.
Medical information that may be requested by the Agency is listed in Title 5 of the Code of Federal Regulations (“CFR”) Part 339.104. Such requests should be limited to necessary and relevant information. In accordance with the regulations, the EEOC has advised that requests for medical documentation be limited to the information a supervisor needs to resolve the pending employment decision. Specifically, relevant regulations and case law provide that an employer may only seek information about an employee’s medical condition when it is “job related and consistent with business necessity.” A supervisor may not request a copy of an employee’s complete medical records, which may contain unrelated medical information. Documentation should be considered sufficient if it: 1) describes the nature, severity, and duration of the employee’s impairment; 2) the activity or activities that the impairment limits; 3) the extent to which the impairment limits the employee’s ability to perform the activity or activities; and 4) substantiates why the reasonable accommodation is needed.
For example, a request for medical documentation may contain: 1) a straightforward explanation of why the information is needed, 2) identify who will review the documentation, 3) a summary of the employee’s job duties and responsibilities (a position description may be attached), including any pertinent physical requirements and environmental factors; and 4) a description of the information the supervisor needs to know to make an informed decision. Information that may be appropriate for the physician to provide may include:
- If the employee has a medical condition, how does that condition affect his/her ability to do the critical aspects of the job?
- The anticipated duration of the medical condition.
- Will there be any restrictions? If so, what are the restrictions and how long will they be required?
- How will any recommended accommodation or consideration allow the employee to perform the critical aspects of the job?
- When will the employee be able to return to his/her job on either a full or part-time basis?
Please note, however, that medical documentation should only be requested if the employee’s disability or need for reasonable accommodation is not obvious or if the information initially provided is insufficient. For example, it would not be necessary to obtain medical information from an employee who uses a wheelchair in order to respond to a request for a physical accommodation in the workplace. Thus, a supervisor may only request medical information that is necessary to determine whether the employee is disabled or if an accommodation is needed.
Occasionally, a supervisor may need to request supplemental medical documentation to obtain more information about the medical basis on which the health care provider made his/her conclusions (i.e., diagnostic tests, evaluations, etc.); obtain a clear explanation of the nature of the disability or need for reasonable accommodation; or, to clarify how the reasonable accommodation requested will assist the employee in performing the essential functions of his/her job. The agency may have the documentation reviewed by a medical expert of its choosing, at the agency’s expense.
Requests for medical information/documentation should be tailored to each case. The samples that follow provide suggested language, but care should be taken to ensure that the information requested is appropriate and necessary for the supervisor to make an informed decision. Because each case should be evaluated individually, it is recommended that supervisors contact their servicing Employee Relations Specialist prior to requesting such information.
Finally, any medical information received from an employee or physician should be treated as a confidential record which should only be shared with individuals who are directly involved in making the related management decisions or who have a need to know. Thus, the supervisor may not disclose to other employees that an individual is receiving a reasonable accommodation.
SAMPLES
A supervisor simply needs to know when an employee can return to duty, if there are any restrictions or limitations upon his/her return to duty, and how long those restrictions/limitations must be in place. Such basic information can be relayed from the doctor, through the employee, to the supervisor. Please refer to the Sample Request for Doctor's Statement.
In a more complex case, that requires detailed medical documentation, a supervisor should instruct the employee to provide the information to NIH's Occupational Medical Service for confidential review, interpretation and advice. Please refer to the Sample Request for Medical Documentation.
