Schedule A Medical Documentation Request

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Thank you for your interest in our Schedule A medical documentation services.

Schedule A is a federal hiring authority that allows qualified individuals with certain disabilities to be considered for federal employment through a noncompetitive hiring process. David Medical Services provides independent physician documentation for individuals seeking to establish disability eligibility under Schedule A (5 CFR § 213.3102(u)).

Our physicians review relevant medical documentation to determine whether a Schedule A certification can be medically supported.Please note that Schedule A documentation establishes eligibility for consideration under a federal hiring authority. It does not guarantee employment, establish qualifications for a specific position, or constitute a request for reasonable accommodation.

Please complete the following form so our team can evaluate your request.

Not sure which service you need? Schedule A documentation establishes disability eligibility for a federal hiring pathway. If you need documentation explaining how a medical condition affects your ability to perform job duties or why a workplace accommodation is necessary, please visit the Workplace Accommodations service page on our website, disabilitymedicalevaluations.com.

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Full Name* This field is required.

First Name

Last Name

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Date of Birth* This field is required.

Date

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Email Address* This field is required.

example@example.com

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Phone Number* This field is required.

Area Code

Phone Number

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State of Residence* This field is required.

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Preferred Method of Contact

Email

Phone

Either is acceptable

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Who is completing this form?* This field is required.

I am the applicant.

I am completing this form on behalf of the applicant.

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Please provide your name and relationship to the applicant.

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What is the purpose of your Schedule A documentation request?* This field is required.

I am applying for a federal government position.

I am preparing to apply for federal employment.

A federal agency or recruiter has requested Schedule A documentation.

I am a current federal employee seeking Schedule A documentation.

Other

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Has a federal agency or hiring official specifically requested Schedule A documentation?* This field is required.

Yes

No

Not sure

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If applicable, which federal agency or position is involved?Examples: Department of Veterans Affairs, Department of Defense, Department of Homeland Security, etc.

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Do you have a deadline for submitting your documentation?* This field is required.

Yes

No

Not sure

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Date of Deadline

Date

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Which category best describes the disability for which you are requesting Schedule A documentation?* This field is required.Schedule A applies to individuals with intellectual disabilities, severe physical disabilities, or psychiatric disabilities. Our physicians will determine whether the available medical evidence supports certification under the applicable category.

Severe physical disability

Psychiatric disability

Intellectual disability

I am unsure which category applies

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What medical condition or disability is the basis of your request?* This field is required.Please identify the primary medical condition or disability for which you are requesting documentation. You do not need to provide your entire medical history.

0/100

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Has this condition been diagnosed by a licensed healthcare professional?* This field is required.

Yes

No

Currently undergoing evaluation

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Approximately when was the condition diagnosed?Year of diagnosis is sufficient if you cannot remember a specific date.

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Is the condition currently being treated or monitored by a healthcare professional?* This field is required.

Yes

No

Previously treated, but not currently receiving care

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Please briefly describe how your condition affects your daily activities or functioning.* This field is required.You may describe relevant physical, cognitive, psychological, or other limitations. A detailed employment history is not necessary.

0/100

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What supporting medical documentation do you currently have available?* This field is required.

Medical records confirming my diagnosis

Specialist evaluation or consultation report

Psychological or psychiatric evaluation

Disability determination or benefits documentation

Letter or statement from my treating healthcare professional

Other medical documentation

I do not currently have supporting documentation

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Have you previously received documentation confirming disability eligibility under Schedule A?* This field is required.

Yes

No

Not sure

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Why are you requesting new Schedule A documentation?* This field is required.

0/100

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Have you been previously denied or informed that you did not qualify for Schedule A documentation?* This field is required.

Yes

No

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Is there anything else you would like our physicians to know about your request?

0/100

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Please acknowledge the following statements:* This field is required.

I understand that Schedule A medical documentation is based on independent physician review of the available medical evidence. Submission of this request does not guarantee that a physician can provide a favorable certification.

I understand that Schedule A documentation establishes disability eligibility for consideration under a federal hiring authority but does not guarantee employment or establish my qualifications for a particular position.

I understand that the standard Schedule A Documentation Service includes review of up to 25 pages of relevant evidentiary documentation. Additional records if needed, may involve additional fees.

I understand that payment is required before physician review begins and that fees are nonrefundable once work has commenced, in accordance with the service agreement.

I understand that this service provides an independent medical evaluation of the submitted documentation and does not establish an ongoing treating physician–patient relationship.

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Please verify that you are human* This field is required.