Disability Accommodation Medical Provider Statement PDF (Free)
Generate a concise medical provider statement to support disability accommodations.
Published December 3, 2025
Employers and schools often need a provider statement to approve accommodations. Use this free PDF tool to outline diagnoses, functional limitations, and recommended adjustments in a clean format.
When to use this
- HR or disability services asked for a provider statement to support an accommodation request.
- You need to explain functional limitations for remote work, schedule changes, or assistive equipment.
- You want a clear, signed letter to accompany ADA, FMLA, or school accommodation paperwork.
How to do it (fast)
- Open /tools/disability-medical-provider-statement-pdf.
- Enter the patient and provider information.
- Add diagnoses, functional limitations, and recommended accommodations.
- Include start date and duration, then generate and download the PDF.
Why this helps
- Creates a professional, readable statement that answers common HR and disability office questions.
- Keeps medical details concise while highlighting functional limitations and accommodations.
- Downloads privately so sensitive information stays on your device until you share it.
Related tools
- Disability Accommodation Request Log PDF
- Medical Appointment Work Note Log PDF
- Medical Leave Request Letter PDF
Not legal advice. Courts set their own rules. Keep your original records.