Sample Disability Letter Template (Page 2 of 3) in pdf

If you request, I can again forward the majority of Jane’s medical records, if you have a file cabinet

large enough to hold them! Be assured that I will forward them upon request.

The level of severity of Jane’s medical symptoms as well as her medical symptoms themselves

increase each year. She eventually lost use of her urinary bladder and it being surgically removed

has caused her to live with a urostomy through her abdomen. The urostomy continues to plague

Jane yet today as it does not function properly due to a surgical intervention that was performed to

relieve her chronic abdominal pain. This surgery resulted in the formation of post surgical

adhesions to form around her ureters rendering one ureter useless and creating a new medical

condition called, ”Nepheritis.” This condition causes cessation of her ability to urinate via the

urostomy and the urine backflows into her kidneys causing chronic urosepsis! This infection of her

kidneys frequently places Jane in a special sterile unit in the local medical center for very high

doses of antibiotic IV therapy. This condition also renders her susceptible to infections from others

so she cannot be exposed to visitors while in the hospital, at times up to three weeks in patient.

Jane has undergone 26 laporotomies due to her chronic abdominal/pelvic pain, and as a result of

those surgeries, Jane lost her urinary bladder, her reproductive organs, her gall bladder and her

appendix! Jane has also had the pleasure of undergoing several intestinal repairs due to her

intestines being sliced through during a surgery to help relieve her chronic abdominal/pelvic pain!

Jane not only has the medical conditions mentioned above, but she now suffers with multiple

hernia’s of her rectus muscle. These massive hernias have caused her intestines to prolapsed out

of her urostomy opening ( os ) and are lying against the skin of her abdomen as there is no rectus

muscle left from the surgeries that were meant to repair the hernias! Jane can no longer fit an

ostomy urine collection bag over her urostomy due to these intestinal protrusions causing an ill fit for

the bags and she has had to resort to taping Kotex napkins over the os to catch the urine.

My observations of Jane’s moods, when and where..:

Jane tries very hard to face each day, but it is a very difficulty thing for her to do even when she

wish’s to socialize. Jane leaks urine when she stands or walks, she has to at time carry a urine bag

around if she can utilize an indweeling catheter in the os of the urostomy, thus allowing her to urinate

into the bag and forgo the taping of the Kotex over her ostomy site. There is an offensive order that

surrounds conditions such as hers, and she is aware of that existing. She is very hesitant to

socialize, which she doesn’t do much of at all. Jane is anti social, but who wouldn’t be. Times and

dates again.. how about this: Everyday, everywhere and all the time Jane lives like this. And she

handles it the best she can.

I see her cry, I see her loneliness, she has very few friends, near non to be exact. She has no male

companionship, which is two fold in her life. She is unwilling to have male companionship due to a

fear of presenting herself as she appears, I only assume that of course. She appears to have no

desire for male companionship at all. I have noticed that a male friend does call her now and then,

and he is kind and compassionate, but Jane has always and continues to refuse to see him.

Sample Disability Letter Template Page 2