To submit the Riverside Medical History Questionnaire, you can either email the completed form to HR@riversidehealth.com or fax it to (555) 123-4567. For physical delivery, send it to Riverside Health Human Resources at 123 Main St, Anytown, VA 12345. Online submissions can also be accepted through the employee portal, so check with HR for access details.

Important dates for submitting this form are typically aligned with employment start dates. New employees should complete the form before their first day. Check with HR for specific deadlines related to your position.

The Riverside Medical History Questionnaire is designed to ensure the health and safety of employees in accordance with ADA regulations. It collects vital medical information that assists employers in providing reasonable accommodations for individuals with disabilities. This form plays a critical role in the hiring process, helping to identify any health-related factors that could affect job performance.

• 1. Name: The full name of the individual filling out the form.
• 2. Address: Residential address for contact purposes.
• 3. Telephone: Primary phone number for communication.
• 4. Email: Email address for further correspondence.
• 5. DOB: Date of birth for identification.
• 6. Family Physician: The name of the individual's primary healthcare provider.
• 7. Emergency Contact: Details of a person to contact in case of emergencies.
• 8. Medical History Questions: A series of health-related questions with options to answer YES or NO.

Failure to submit this form may lead to delays in the hiring process or result in the loss of job offers. Moreover, insufficient medical information may hinder employers from making necessary accommodations, which can affect employee health and safety.

• Delayed Employment Start: If the form is not submitted, the individual may not be able to commence work as planned.
• Inability to Provide Accommodations: Without accurate medical history, employers may struggle to accommodate health needs.
• Potential Job Offer Withdrawal: Failure to provide necessary information can lead to retraction of job offers.

• 1. Before Starting Employment: Complete this form as part of the pre-employment process.
• 2. Annual Health Assessments: Some employers may require annual or periodic updates of this form.
• 3. When Requesting Accommodations: Utilize this form to inform employers of any necessary workplace adjustments.