Medical 504 form 2026

1. Click ‘Get Form’ to open the medical 504 form in the editor.
2. Begin by entering the student's name, date of birth, school name, and student ID number in the designated fields at the top of the form.
3. In section one, select the appropriate medical diagnosis or disability from the provided options. If applicable, include ICD-10 or DSM-V codes.
4. Indicate whether the condition is temporary by checking 'Yes' or 'No' and specify the estimated duration if it is temporary.
5. Complete the accommodations table by listing requested accommodations for each diagnosis. Ensure to check relevant boxes for specific needs.
6. Provide details on how the diagnosis affects educational performance and list any necessary tasks for a paraprofessional if applicable.
7. Fill out health care practitioner information including name, contact details, and signature at the bottom of the form.

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