Other Health Impairment Eligibility Determination Form 2026

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The document is an Other Health Impairment (OHI) Eligibility Determination Form used by the Admissions and Release Committee (ARC) to assess a student's eligibility for special education services due to health impairments. It outlines the criteria for determining eligibility, including the presence of a health impairment, its impact on educational performance, and the need for specially designed instruction. The form requires documentation of evaluation data and allows for re-determination of eligibility.

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Click ‘Get Form’ to open the Other Health Impairment Eligibility Determination Form in the editor.
Begin by entering the student’s full name, SSID, date of birth, and date of eligibility determination in the designated fields.
Fill in the school name where the student is enrolled. This information is crucial for proper documentation.
In section 1a, indicate whether a health impairment exists by selecting 'Y' for Yes or 'N' for No. Specify the type of health impairment if applicable.
Proceed to section 1b and assess if the student has limitations in strength, vitality, or alertness due to their health condition. Mark accordingly.
Continue through sections 2, 3, and 4 to confirm that evaluation information supports adverse effects on educational performance without being influenced by other factors.
On the following page, provide supporting documentation that substantiates your findings and conclusions regarding eligibility.

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What is an ohi form?

Other Health Insurance (OHI) Questionnaire. TRICARE West Region. Use this form to report other health insurance (OHI) that might be available to you or your family members.

What is the ohi form?

Whats central to all the disabilities falling under Other Health Impairment is that the child must have: limited strength, vitality, or alertness due to chronic health problems; and. an educational performance that is negatively affected as a result.

What are some examples of OHI being used?

Use the links to jump to more information about each of these disabilities. ADD and AH/HD. Diabetes. Epilepsy. Heart conditions. Hemophilia. Lead poisoning. Leukemia. Nephritis.

What qualifies for OHI?

Other Health Impairment (OHI) is a broad category that covers conditions that limit a childs strength, energy, or alertness. Examples include ADHD, Anxiety, Bipolar Disorder, Depression.

What is the purpose of ohi?

The Organizational Health Index is a leading indicator of your organizations ability to achieve sustained improvements in performance. It measures organizational health based on our proprietary organizational health outcomes, management practices, and employee experience themes.

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