Disability Accommodation Medical Provider Statement

Create a formal provider statement that outlines diagnoses, functional limitations, and recommended accommodations for HR or disability offices.

Provider statement builder

Draft a concise provider statement that documents limitations and accommodations for disability or HR requests.

Patient name

Provider name

Practice or clinic

Start date

Expected duration

Diagnosis or condition

Functional limitations

Recommended accommodations

No account needed. Your details stay in your browser.

Processing stays in your browser. PDFs generate locally—no uploads or accounts.
Downloads use a secure PDF blob helper (no raw array buffers or workers required).
Review details before sending; nothing here is legal advice or a substitute for local forms.