The following is not legal advice. It is simply an example of a letter that may be used to ask for accommodations.
The form is not a guarantee that the request will be granted.
Please consult a lawyer or legal clinic for advice about your particular situation.
Some clinics that may be able to assist you, include those listed on this site: http://www.bchrt.bc.ca/whocanhelp/index.htm
A fillable PDF version of the below can be accessed here.
Date: ______________________________
Dear (clinic or administrator),
My name is __________________________________ and I have a ______________________________ procedure scheduled on _____________ at _______ am/pm in the _____________________________________ department/clinic.
I have risk factors for severe COVID-19 disease as recognized by the Government of Canada. https://www.canada.ca/en/public-health/services/publications/diseases-conditions/people-high-risk-for-severe-illness-covid-19.html
I respectfully request the following accommodations, which can be provided without undue hardship, to ensure that I have meaningful access to my medical services without adverse impact on my health, as protected by the B.C. Human Rights Code:
1. All health care workers in my presence and those providing care to me must at all times be masked in N95 respirators or elastomeric respirators;
2. I will be permitted to wear an N95 respirator or elastomeric respirator of my choosing in the hospital/clinic (as applicable);
3. I will be permitted to monitor the ventilation in the room and to bring and use standalone True HEPA filters to filter the air.
4. Health care workers and others providing care to me will refrain from the use of harassing or discriminatory speech directed at me and will not make complaints about the necessity of wearing a mask in my presence.
Add any other accommodations required below:
Please confirm in writing by _____date_____ that you will make arrangements for these accommodations for me.
Thank you in advance for your anticipated cooperation.
Signed______________________
