Appendix 1. Common Patient Requests for Work Restrictions and

Jackson RA, Gardner S, Torres LN, Huchko MJ, Zlatnik MG, Williams JC. The authors provided this information as a

supplement to their article. My obstetrician got me fired: how work notes can harm pregnant patients and what to do about it. .

Obstet Gynecol 2015;126.



Appendix1.CommonPatientRequestsforWorkRestrictionsandTheirEmployment

Implications



Patient

requestfor

work

restriction

Languageused

innote

Implicationsofthistype

ofnoteonemployment

Howtoimprovenote

“CanIhavea

notethat

statesIdon’t

havetoliftand

bendat

work?”

“Ms.Cshould

notliftmore

than10lbsor

perform

activitiesthat

require

bending.”

Ifliftingmorethan10lbs

orbendingareessential

functionsofherjob,

theremaybeno

reasonable

accommodationthather

employercanprovide.

Shemayberequiredto

takeleavestarting

immediately.Onceher

family

leaveisexhausted,

shemustreturntowork

Liftingisnotgenerally

contraindicatedinpregnancy.

However,ifMs.Chasback

painorpregnancyis

exacerbatingabackinjury,

accommodationsmaybe

appropriate:“Ms.Ccan

continuetoperformmost

functionsofherjobwhile

pregnant.Shehasa

pregnancy‐relatedback

conditionthatrequiresherto

Jackson RA, Gardner S, Torres LN, Huchko MJ, Zlatnik MG, Williams JC. The authors provided this information as a

supplement to their article. My obstetrician got me fired: how work notes can harm pregnant patients and what to do about it. .

Obstet Gynecol 2015;126.



Patient

requestfor

work

restriction

Languageused

innote

Implicationsofthistype

ofnoteonemployment

Howtoimprovenote

orshowthatshehasa

disabilityrequiring

accommodationsuchas

finitemedicalleave.If

not,shecanbe

terminated.



limitliftingtonomorethan

20poundstwiceperhour.”

“Ineedtogo

onleave

becauseIcan’t

checkmy

sugarsat

work.”

“Ms.Aneeds

tobeableto

checkher

bloodglucose

atwork.”

Thisnotelacksreference

tothepatient’smedical

condition(GDM)and

needstobemore

specific.

Explaintheimplicationsof

goingonleaveearlyin

pregnancytothepatient,and

suggestthataccommodations

willlikelyallowherto

continueworking:“Ms.Ahas

apregnancy‐relatedcondition

calledgestationaldiabetes

thatrequireshertomonitor

Jackson RA, Gardner S, Torres LN, Huchko MJ, Zlatnik MG, Williams JC. The authors provided this information as a

supplement to their article. My obstetrician got me fired: how work notes can harm pregnant patients and what to do about it. .

Obstet Gynecol 2015;126.



Patient

requestfor

work

restriction

Languageused

innote

Implicationsofthistype

ofnoteonemployment

Howtoimprovenote

herbloodglucoselevelwitha

simpletestandtoeatsmall

snacksevery2‐3hours.She

willneedaprivatespacein

whichtocheckherglucose.”



“Myworkis

toostressful,

andI’m

worrieditis

harmingmy

pregnancy.”

“Ms.Bneeds

tobekeptina

stress‐free

environment

duringthis

pregnancy.”

Workinginastress‐filled

environmentmaybean

essentialfunctionofher

job(e.g.,shemaybean

attorney,acustomer

servicerepresentative

or

physician).Further,

removingstressisnota

“reasonable”

accommodation.Finally,

Giventhatthereisno

pregnancy‐related

impairment,itisnot

recommendedtorequest

accommodations.If,

however,amentalhealth

diagnosisexists,

accommodationscanbe

requested.



Jackson RA, Gardner S, Torres LN, Huchko MJ, Zlatnik MG, Williams JC. The authors provided this information as a

supplement to their article. My obstetrician got me fired: how work notes can harm pregnant patients and what to do about it. .

Obstet Gynecol 2015;126.



Patient

requestfor

work

restriction

Languageused

innote

Implicationsofthistype

ofnoteonemployment

Howtoimprovenote

nopregnancyrelated

impairmenthasbeen

identified.



“I’mtootired

toworkfull‐

time.”

“Ms.Dmust

havereduced

workhours

duringthis

pregnancy.”

Whilesomeemployers

maybeabletoofferpart‐

timework,otherswill

countthistowardher

leavetherebyreducing

thetotalleaveavailable

fordeliveryandpost‐

partum.Intermittent

leavemaybea



reasonable

accommodationunder

theADA.

Confirmfatigueissevere

enoughtosignificantlylimita

majorlifeactivity.Modest

modificationsmaybe

sufficient:“Ms.Dhas

clinicallysignificantfatigue

relatedtoherpregnancy.She

cancontinuetoworkwith

>50%ofhertimeatwork

spentseatedand15minute

breaksevery4hours.”



Jackson RA, Gardner S, Torres LN, Huchko MJ, Zlatnik MG, Williams JC. The authors provided this information as a

supplement to their article. My obstetrician got me fired: how work notes can harm pregnant patients and what to do about it. .

Obstet Gynecol 2015;126.



Appendix2.CommonPregnancy‐RelatedImpairmentsandPossibleWorkplace

Condition Limitation Reasonableaccommodations^

Backpain Prolongedor

repetitivelifting,

bending,orsitting

Useofaheatingpad,sittinginsteadof

standing,liftingassistanceorlimitations,

assistiveequipmenttolift,or

modificationofthedutiesofthejob,such

astemporarylightduty



Venous

thrombosis

Prolonged

sedentaryactivity

Modificationofworkstation,breaksfor

exercise,privateareainwhichto

administerinjections



Carpaltunnel

syndrome

Repetitivetasks

usinghands

Occasionalbreaksfrommanualtasksor

typing,specializedprogramsthatallow

fordictationinsteadoftyping,

modificationofworkstationtoprovide

wristsupport

whiletyping



Jackson RA, Gardner S, Torres LN, Huchko MJ, Zlatnik MG, Williams JC. The authors provided this information as a

supplement to their article. My obstetrician got me fired: how work notes can harm pregnant patients and what to do about it. .

Obstet Gynecol 2015;126.



Chronic

migraines

Exposuretobright

lightsorloud

environments



Changelightingintheworkarea,limit

exposuretonoiseandfragrances,change

schedulesuchasflexiblescheduleor

telework



Dependent

edema

Prolongedstanding Stoolorchairtositonwhileworking;

morefrequentrestbreaks;modification

offootwearrequirements



Dyspnea Abilitytoperform

strenuousactivities



Stoolorchairtositonwhileworking,

morefrequentrestbreaks



Fatigue Abilitytoperform

strenuousactivities

ortoworklong

hours



Lightdutytoavoidstrenuousactivity,

flexibleorreducedhours,exemption

frommandatoryovertime,intermittent

leave



Jackson RA, Gardner S, Torres LN, Huchko MJ, Zlatnik MG, Williams JC. The authors provided this information as a

supplement to their article. My obstetrician got me fired: how work notes can harm pregnant patients and what to do about it. .

Obstet Gynecol 2015;126.



Gestational

diabetes

Abilitytowork

prolongedperiods

withoutbreaksand

snacks



Permissiontotakemorefrequent

bathroombreaks,toeatsmallsnacks,a

privateareafortestingbloodglucose,

timeoffformedicalappointments



Hyperemesis

gravidarum;

nausea/vomiting



Abilitytowork

prolongedperiods

withoutbathroom

breaksandsnacks.



Permissiontotakemorefrequent

bathroombreaks,toeatsmallsnacks

duringworkhours,modifiedschedules

includingworkingfromhome



Hypertension Strenuousor

prolongedphysical

activity

Stoolorchairforemployeetositonwhile

working;limitliftingandbending

requirements,workfromhomewhileon

bedrest



Urinarytract

infections

Abilitytowork

prolongedperiods

withoutdrinkingor

usingtherestroom

Waterbottleatworkstation,more

frequentbathroombreaks

Jackson RA, Gardner S, Torres LN, Huchko MJ, Zlatnik MG, Williams JC. The authors provided this information as a

supplement to their article. My obstetrician got me fired: how work notes can harm pregnant patients and what to do about it. .

Obstet Gynecol 2015;126.



^Theappropriateaccommodationineachcasewillvarydepending

uponthewoman’sconditionandherjob.Seealso:Job

AccommodationNetwork,www.askjan.org.



Jackson RA, Gardner S, Torres LN, Huchko MJ, Zlatnik MG, Williams JC. The authors provided this information as a

supplement to their article. My obstetrician got me fired: how work notes can harm pregnant patients and what to do about it. .

Obstet Gynecol 2015;126.



Appendix3.SampleWorkModificationLetter



ToWhomItMayConcern:



OnJune15,2014,mypatientMs.JaneDoeconsultedwithmeinmyoffice.IdiagnosedMs.Doe,whois

pregnant,withcarpaltunnelsyndrome.Consistentwiththis diagnosis,Ms.Doeneedsan

accommodationatworkuntil

herbabyisborn,onoraroundNovember1,2014.



BecauseofMs.Doe’scarpaltunnelsyndrome,andherassociatedlimitationonrepetitiveuseofboth

handsformorethan30minuteswithoutabreak,sheishavingdifficultytyping forlongperiodsoftime

andshouldbeallowedtotake

a5‐minutebreakafter30minutesofcontinuoustyping.



Formoreinformation,youmaywishtoconsulttheJobAccommodationNetworkatwww.askjan.org.



Sincerely,

Providernameandcontactinformation