dChan - Q Origins Project Archive

Take This Template To Your Doctor So They Have A Starting Point For Your Letter, or Have Your Doctor Complete This Letter With Your Particulars!

To Whom This May Concern,

_______ is medically exempt from any regulation mandating face mask usage or any other airway restriction for any reason. (NOTE*** you are not required to disclose your medical diagnosis, history or condition. If you are concerned about your confidential medical history being exposed to non-authorized and non-consented individuals, talk to you doctor about this concern. That information can and usually is left off the letters. If this is NOT a concern of yours, then you can add the medical history at the end of the above sentence.)

Wearing a mask will pose a far greater health risk to this individual including but not limited to a compromised airway, increased risk of hypoxia, pseudohypoxia, hypercapnia and significantly increase the risk for histotoxic hypoxic injury. In addition, the results of wearing a mask will increase the cortisol levels inducing a sympathetomimetic drive, decreasing the lymphocyte subpopulation, increasing suppression of the immune system resulting in physical and medical harm that could be easily be preventable.

Under the Americans Disability Act (ADA) and HIPPA, a patient is NOT required to disclose his or her medical condition. It should be noted that any individual, organization, business or agency could be fined up to $75,000 for the first ADA violation and up to $150,000 for any subsequent violations.

The Americans with Disabilities Act of 1990, 42 U.S.C. §§ 12131-12134, and Section 504 of the Rehabilitation Act of 1973, 29 U.S.C. § 794 provides for enforcement activities against an entity alleged to have violated federal law, required to be disclosed under the Freedom of Information Act, 5 U.S.C. § 552. For more information, feel free to contact the Department of Justice ADA Violation Information Line at 800-514-0300.

Thank you,

Your Doctor’s Signature

Note to “patients of record” (patient at Centers for Advanced Medicine): If you need this letter for a medical condition preventing you from wearing a face mask for any reason, talk to your provider during your scheduled consultation.

Note to “non-patients”: We do NOT provide any services to individuals who are NOT patients of record.

General note to everyone: If you feel your health has been compromised and your rights under the ADA and HIPPA have been violated, contact 800-514-0301 (voice) or 800-514-0383 (TTY) to file a complaint. Make sure you have the name of the agency/organization as well as the individual’s name/ID number who was responsible for violating the Americans Disability Act.

https://www.askdrbuttar.com/facemask/fm3/