Letter to a Worker's Doctor (UK) (Acas)
This letter template allows an employer or organization to formally request medical information from a worker's doctor. It is used to gather details for managing sick pay, planning work, or providing necessary support to the worker. The template ensures that all requests are made with the worker's explicit permission.
Template Letter to a Worker's Doctor
To: [doctor name]
[doctor address]
From: [requester name]
[organization name]
[organization address]
[date]
Dear [doctor name]
I am writing for information about your patient [worker name], who lives at [worker address].
I am a / an [your role] at [organization name]. Your patient works as a / an [worker 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,
[requester name]
[your telephone number]
[your email address]
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About this template
What is this template?
This document is a structured request for medical information and is not a contract of employment or a standalone medical consent form. It specifically contains placeholders for worker tasks such as 'heavy lifting' and 'using a keyboard' to contextualize the doctor's advice.
When should you use it?
Use this letter when an employee has provided consent for their employer to contact their GP regarding fitness for work. Use a 'Letter of Consent for Medical Report' instead if you have not yet obtained the worker's permission.
What's inside
| Clause | Name | What it does |
|---|---|---|
| Paragraph 3 | Worker Consent and Report Review | Confirms that worker permission is attached and specifies if the patient wishes to see the report before the requester. |
| Paragraph 4 | Purpose of Information Request | States the employer's need for information to manage sick pay, plan work, or support the worker. |
| Worker Tasks | Condition Impact and Tasks | Details specific duties like heavy lifting or driving that the health condition might affect. |
| Additional Information | Reasonable Adjustments and Phased Return | Asks the doctor to identify necessary reasonable adjustments and estimate a likely return to work date. |
| Paragraph 8 | Payment of Fees | Contains a request for the doctor to notify the employer if a fee is required for the report. |
Who it's for
- an employer needing medical evidence to manage a worker's sickness absence
- an HR manager assessing reasonable adjustments for a disabled worker
- a UK organisation planning a phased return to work for an employee
How long it runs and how it's signed
England & Wales note
This version is drafted for England & Wales. Scotland and Northern Ireland differ on some points — for example notice periods and tribunal procedure. Tell GitLaw where you hire and it adjusts the draft.
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