Medical report request to GP letter template

I write with regard to one of your patients, [name], who has given [his | her | their] written permission to request a medical report on [his | her | their] current state of health, copy enclosed.

[[Name] has been absent from [date].]

As [his | her | their] employer, we are concerned as to [whether | when] [name] will be able to [perform | return to] [his | her | their] normal duties. Although we have discussed this with [him | her | them], it is necessary to seek a medical opinion as to when, and if, [he | she | they] will be well enough to [be able to return work and] undertake [his | her | their] normal duties.

In order to assist you in establishing [name]'s fitness for work I have outlined below [his | her | their] job requirements, working hours and general work:

Job Title:

Hours of Work:

Place of Work:

Duties include:

• [list key job duties here]

In addition to your medical assessment on the above matters, I should be grateful if you would respond to the following specific questions:

1. Please would you list all the conditions which [name] has and/or the reasons [he | she | they] [is | are] unfit for work at this time?
2. What treatment has [name] had to date for these conditions?
3. [Is | are] [he | she | they] still undergoing treatment at present?
4. In addition to past and current treatment is there any other treatment expected which would be on-going?
5. [When [name] returns to work] would any of these conditions have an impact on [his | her | their] ability to carry out [his | her | their] duties?
6. Is [name] likely to be able to return to work in the foreseeable future and, if so, what is the prognosis for [his | her | their] recovery and return to work date?
7. Are there any reasonable adjustments that the Company could make to facilitate [name]'s early return to work?
8. If no adjustments can be made to [name]'s current role, is there any other type of work that [name] may be able to perform (irrespective of whether that work is available in our organisation)? If so, what is that type of work, and when might [name] be able to perform that work?/li>
9. We would like to try to establish whether [name] is disabled under the Equality Act 2010. The legal definition of a disabled person is someone who has a physical or mental impairment, which has a substantial and long-term adverse effect on a person's ability to carry out normal day-to-day activities. In this context, I would be grateful if you could confirm:
   1. Whether you would class the condition/s listed in your response to question 1 above as a physical or mental impairment/s?
   2. How long this impairment/s has lasted for; how long it is likely to last for; or whether it is likely to reoccur?/li>
   3. What activities the impairment/s either prevent [name] from doing or mean [he | she | they] can only do with difficulty. When answering this question, please could you consider what [name] could not do if [he | she | they] did not have the benefit of any corrective measures such as medication, aids etc.

[[Company] is in the [nuclear | security | other] industry. [Name] holds [DV | SC] clearance[ and is in a high risk role]. [Name] may have medical conditions have the potential to be a security (and safety) concern, such as psychological disorders or other medical conditions where symptoms may include an occasional loss of consciousness or physical weakness, or a reliance on drugs or alcohol. As a medical professional, I would be grateful if you would establish any potential security (or safety) concerns that exist. This will also be influenced by the job role detailed above, and you may need to discuss the potential of risks with [name].]

Under the provisions of the Access to Medical Reports Act 1988, I am obliged to inform you that [name] has been notified that we are seeking a medical report, as evidenced by [his | her | their] written permission, and that [he | she | they] [has | have] indicated that [he | she | they] [does | do] [not] wish to have access to the Report before it is supplied to us.

I am grateful for your assistance in this matter, and I look forward to receiving your report at your earliest convenience.