Letter to a Worker's Doctor by Acas
This template is a formal letter for an employer or organization representative to send to a worker's doctor. It requests specific medical information about the worker, such as absence dates, health conditions, and their impact on job responsibilities, to assist with sick pay management, work planning, or worker support. The letter includes placeholders for details like the worker's permission and specific information needed.
Letter to a Worker's Doctor
To: [doctor’s name]
[Doctor’s address]
From: [your name]
[Name of your organisation]
[Address of your organisation]
[Today’s date]
Dear [doctor’s name]
I am writing for information about your patient [name of worker], who lives at [address of worker].
I am [a / an] [your role] at [name of your organisation]. Your patient works as [a / an] [worker’s job title] at the organisation.
I have attached the worker’s permission for me to make this request. They [want / do not want] to see the report before you send it to me.
I would like information in order to manage [sick pay / plan work / support the worker].
I would like information about:
[List the things you’re asking about. For example:
their absence from work, including absence dates
their health condition, such as a broken wrist]
Their role involves:
[List any worker tasks or responsibilities the condition might affect. For example:
standing for long periods
heavy lifting
working evenings
using a keyboard
driving]
I would like to know:
[List any other information you need. For example:
the condition's impact on carrying out their tasks or responsibilities
whether the worker is disabled
reasonable adjustments that might be needed
a likely date the worker will return to work
if a phased return to work, change of duties or other support might help the worker]
Let me know if I need to pay a fee for this information.
If you’re unable to provide the requested information quickly, please reply to confirm you’ve received this.
Please reply [by email / by post - a stamped addressed envelope is enclosed].
Yours sincerely,
[Your name]
[Your telephone number]
[Your email address]
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