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Selected note-writing instructions for work accommodations

Selected note-writing instructions for work accommodations
Guideline Model note language To avoid
State patient is pregnant and needs an accommodation. "Patient is affected by pregnancy, childbirth, or lactation (whichever relevant) and requires an accommodation." It is the patient's decision if she does not want to reveal her pregnancy, but she may be less likely to receive an accommodation.
Identify patient's pregnancy-related medical conditions (eg, severe back pain, gestational diabetes, etc), if any. Depends on the state. In some states, disclosure of specific medical condition is not required. In some states, identifying specific condition and other medical details may be necessary to receive an accommodation. Visit www.pregnantatwork.org/healthcare-professionals/ for state-by-state guidelines. If guidelines at www.pregnantatwork.org/healthcare-professionals/ say that the disclosure of medical condition is not necessary in your state, maintain your patient's privacy.
Specifically and precisely identify work limitations that are recommended medically. Patient "is unable to stand for more than one hour without 15 minutes of sitting," "may not climb ladders," or "must take 15-minute breaks every three hours to eat a snack." Avoid vague statements, such as "needs light duty" or "no physical activity." Also avoid imposing restrictions that are not medically indicated, because the patient could be sent out on unpaid leave or terminated if accommodation is not possible.
Affirmatively state that the patient can continue working. "Patient is able to continue working with a reasonable accommodation." This does not apply in situations in which the patient requires leave, for example to recover after cesarean delivery.
Recommend reasonable accommodations based on your knowledge of the workplace. "I recommend that my patient be given a stool to sit on while checking out customers at the cash register." Avoid recommending specific accommodations without talking to your patient about what is possible in her workplace.
State expected duration of the accommodation. "Patient's medical limitation and need for accommodation began on [DATE]. I anticipate the patient will need an accommodation until [DATE]." Do not fail to include end date just because end date is uncertain. It can be changed in the future if necessary.
Reproduced from: Karkowsky CE, Morris L. Pregnant at work: Time for prenatal care providers to act. Am J Obstet Gynecol 2016; 215:306.e1. Table used with the permission of Elsevier Inc. All rights reserved.
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