Letter — request to doctor for pre-employment medical report or examination
[insert date]
[insert name and address of doctor]
Dear [insert doctor’s name]
Request for medical [examination and] report on [insert prospective employee’s name]
We are the prospective employer of the above-named individual whom we have offered the position of [insert job title], conditional upon, amongst other criteria, our being satisfied of their fitness to undertake their proposed duties.
This letter confirms our [request/instructions] to you to produce a report on their medical condition.
We also confirm our arrangement for you to examine them at [ ] am/pm] on [insert date] at [insert address]. Please include consideration of the following matters within the scope of your [examination/report]: [insert specific questions]
We enclose a form they have completed consenting to:
• [our obtaining a medical report from you]
• [undergo a medical examination by you]
• [your being given access to their medical records by their general/specialist medical practitioner [insert name• ] of [insert address• ]]
• [your discussing your findings with us after producing your report]
• the processing of their sensitive personal data required in order to carry out the above, as required under the Data Protection Act 1998
We have given them a statement of their rights under the Access to Medical Reports Act 1988, including their right to change their mind about viewing the report before it is sent to us.. We are also sending them a copy of this letter.
[Please note that they have decided that they do [not] wish to see the medical report before it is sent to the Company [so you should not supply the report to us unless:
(a) you have first given them access to the report; or
(b) 21 days have elapsed since the date of this letter and you have not been contacted by them to arrange to view the report.
Please also note that they should be given the opportunity to make a written request for amendments to the report prior to its being supplied to the Company. If you agree to the amendments, you are entitled to amend the report accordingly. If you are not willing to amend the report, they may ask you to attach a statement of their views to the report.]
[We would be grateful for an early indication of the likely timescale involved in producing your report] We look forward to receiving it as soon as possible, together with a note of your fees.
Please feel free to contact me if I can be of further assistance.
Yours sincerely
[signature]
[insert name]
For and on behalf of [insert name of employer]