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Human Resources · Process Guide
HR Accommodation Guide
How to handle a Hyperemesis Gravidarum accommodation request well: what to document, what not to ask, how to protect confidentiality, and how to keep the arrangement working as the condition changes.
For: HR & people teamsRead: 9 minutesFormat: Letter · circulate internally
Why HG needs a different process
Most accommodation processes assume a stable condition and a one-time adjustment. Hyperemesis Gravidarum is neither. Severity fluctuates week to week, episodes cannot be scheduled, and the employee is often severely depleted at exactly the moment your process asks her to advocate for herself. A process built for a fixed impairment will fail her, and it will fail you — because the outcome is usually resignation.
Treat HG as a fluctuating, episodic condition with an ongoing plan and a scheduled review, not as a single request to be adjudicated once.
The process, in order
01Acknowledge within one business day. Confirm receipt, confirm confidentiality, and confirm that her job is not at risk while this is worked out.
02Ask about function, not diagnosis. What tasks are affected, what would help, what has already stopped working. You do not need clinical detail to act.
03Request documentation once, proportionately. One provider note confirming a pregnancy-related condition and recommended adjustments. Do not require repeat notes per absence.
04Put accommodations in place before paperwork closes. Interim measures cost little and prevent avoidable absence and escalation.
05Write the plan down and share it with her. What was agreed, what was not possible and why, how to report absence, and the review date.
06Brief the manager on obligations, not diagnosis. They need to know what to do, not what she has.
07Review every two weeks. HG changes. So should the plan.
08Begin leave and return planning early — before it becomes urgent.
Document this
Date of request and who received it
Functional limitations described by the employee
Accommodations agreed, with start dates
Anything declined, with the business reason
Absence reporting method agreed
Pay and leave arrangements confirmed in writing
Review dates and outcomes
Who has been informed, and what they were told
Do not ask, do not require
Details of her diagnosis or treatment beyond function
A doctor’s note for each individual episode
That she prove severity by comparison to other pregnancies
That she disclose to colleagues
That she use all sick leave before accommodation begins
That she work while an infusion or appointment is scheduled
Any renegotiation of previously agreed terms
Confirmation of her intention to return as a condition of support
Confidentiality in practice
Who
What they need to know
Direct manager
Which adjustments apply, how absence is reported, who to escalate to. Not the diagnosis.
Team members
Only that arrangements have changed, with wording the employee has approved.
Payroll / benefits
What is required to process pay and leave correctly — nothing more.
Leave, pay, and job security
·State clearly and in writing what is paid, what is unpaid, and how leave accrues while she is out.
·Confirm role, level, and compensation on return. Uncertainty here is often more damaging than the illness.
·Do not count HG-related absence in performance ratings, attendance triggers, or bonus calculations.
·Flag statutory entitlements early so she is not discovering them at week thirty.
·Have a named contact so she is not re-explaining her situation to a new person each time.
The retention case
Replacing an experienced employee typically costs a substantial multiple of the cost of temporary accommodation. Women supported well through HG return and stay. Women who are not, resign — usually quietly, and usually within a year.
THON Tip
The single highest-value sentence in this whole process is the one you say first: "Your job is safe while we work this out." Say it in writing.
In the United States, the Pregnant Workers Fairness Act, the Americans with Disabilities Act, and the Family and Medical Leave Act may apply, alongside state and local law. THON is not a legal authority — confirm your specific obligations with qualified employment counsel.
Part of the THON Employer Toolkit™ · Practical guidance · Last reviewed July 2026 · Next review January 2027
This resource is educational. It is not legal advice and does not replace guidance from qualified employment counsel or a healthcare professional. Employment protections for pregnancy-related conditions vary by jurisdiction; confirm your obligations locally. © 2026 The House of Nirvana · thehouseofnirvana.org · info@thehouseofnirvana.org · You are not alone.