DISABILITY VERIFICATION Physical Orthopedic Disabilities (to be - wnc 2025

1. Click ‘Get Form’ to open it in the editor.
2. Begin by filling in the patient's name and contact information at the top of the form. This ensures that all documentation is correctly attributed.
3. In section 1, provide a detailed diagnosis along with the date of diagnosis and last contact with the student. This information is crucial for verifying eligibility.
4. Section 2 requires you to describe any physical limitations associated with the disability and provide a prognosis. Be as specific as possible to aid in accommodation planning.
5. In section 3, explain how this medical condition may impact the student's academic progress. This helps Disability Support Services understand necessary support.
6. List current medications in section 4, including dosage and potential side effects, which can inform accommodations.
7. Section 5 asks for any additional treatments being received. Include relevant details to give a comprehensive view of the student's health management.
8. In section 6, outline recommendations for academic accommodations such as extended exam time or specific furniture needs.
9. Finally, use section 7 to express any concerns or additional assistance needed for the student’s success.
10. Ensure you sign and date the form before submitting it via mail or fax to ensure timely processing.

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