Mar 26, 2026 01:45

2026/Mar/26 1:50:30 PM 16043985614->555-1212
To; +16045205552 Page: 09/10 From: Foremed Medical Clinic

* 2026/Mar/24 2:02:13 PM Translink §55-1212 36

Sor eocroe

ira’
ow
DCTC tes

fC

f
Soe

CCUPATIONAL FITNESS ASSESSMENT (OFA) FO!

Date: March 24, 2026
Dear Dr. Ademiluyt
RE: MARK HOLAND

At British Cotumbia Aapid Transit Company (BCRTC) we have a program to explore options to
accommodate vo ' "

employee's fimitations and restrictions In the workplace when these are‘a. result of a medical
condition. We are committed te working with you to assist your patient and to that and, we request
thatyou complete and:return the attached Occupational Fitness Assessment (OFA) so that.we may
undatstand your patiant’s condition In regard to their return te work planning,

In circumstances where an individual is unable to perform the core dutles of thelr position due to
a temporary or permanent disability, BCRTC parties will meet to disctiss and consider the availble
medical evidence regarding the nature of the disabilty-and, If necessary, options with respect te
the accommodation of the emplayee.

BCRTC will safeguard all medical information received about them In accordance with appilcable
privacy legistation.

Please find Included the completed Authorization form allowing disclosure of this Infarmation to
BCRTC Occupational Health.

Instructlons Physician/Health Care Pravider:
1. Ensure your patient has campfatad Employee Consent below.
2, Complete Occupatianal Fitness Assessment (OFA) Farin.
3, Please return the completed..OFA form via. fax°to 604-820-5882. or vis emall to

adehayo_adenpkan@berte.be.ca
ling instructtons

Please fax your Invoice In accordance with BCMA fee schedule for completion of the attached form
ta 604-520- 5552. Please note that we are unable to process an Involcé unless it contalns your
finvolee number and MSP billing number.

Should you require pre-payment, the fea Is pald by the employee and then a recelpt may be
submitted to the employer by the employee for relmbursement.

Thank you, In advanca, for your asslstance, Please contact me If you have any questions.

Best regards,
Adebayo Adenckan, OPhty., B.Kin OCCUPATIONAL HEALTH SPECIAUST
Occupational Health and Wellness

T: 604.902.0253] F:604,520-5552 | translink.ca/berte

Pago tof 4

910
Fax: 1604398561<

EOE er En Ree arc enerenerersentecmpreneg 100088