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Documentation Guidelines for
Medical or Mental Health Conditions
Students seeking accommodations at the University of Southern
Maine must document a disability as defined by the
Rehabilitation Act, Section 504 and the Americans with
Disabilities Act. This documentation must be provided to
the Office of Support for Students with Disabilities (OSSD)
prior to receiving services. Students qualified under these
laws are protected from discrimination in all University
programs, activities, services and facilities.
Under these laws, an individual with a disability means any
person who:
1.
has a
physical or mental impairment which substantially
limits one or more
major
life activities, including caring for oneself,
performing manual tasks,
walking, seeing, hearing, speaking, breathing, learning,
sitting, standing, lifting
and
working, as well as mental and emotional processes such as
thinking,
concentrating
and interacting with others;
2.
has a
record of such an impairment; or,
3.
is
regarded as having such an impairment.
Students
with disabilities must provide evidence of both a disorder and
related current, significant, functional limitations to
become eligible for accommodations. Designed to provide
equal access, accommodations are provided only in response to
the functional limitations of a disability as they clearly
intersect with academic demands. Accommodations do not
include interventions, which are remedial, needed for personal
study and care, or designed to ensure desired outcomes.
Please
provide the following information under separate cover and
on practice letterhead and mail or fax to the above address or
fax. The authorized release of information is to
include but not be limited to the following:
NOTE:
Copies of Medical Records Will Not be Accepted
1.
Presenting
diagnosis (es) utilizing diagnostic categorization or
classification of the ICD or DSM IV. Diagnoses should
indicate primary, secondary, etc., and significant findings,
particularly in respect to presenting problems.
2.
Date
the examination/assessment/ evaluation was performed for the
presenting diagnosis, or if following the student for an
extended time, date of onset and date of an evaluation of the
condition that is recent enough to demonstrate the student’s
current level of functioning.
3.
If a
temporary condition, what is the expected length of time to
recover?
4.
Tests, methodology used to determine disability.
5.
Identify the current functional limitations, if any, on the
student’s physical, perceptual and cognitive performance in
activities such as, mobility, self-care, note taking,
laboratory assignment, testing/examinations, housing
conditions/arrangements.
6.
Describe any treatments, medications, assistive devices or
services the student currently is using. Note their
effectiveness and any side effects that may impact the
student’s physical, perceptual or cognitive performance.
7.
Recommendations for accommodations; explain the relationship
between the student’s functional limitations and the
recommendations.
8.
List
the credentials (certification, licensure and/or training) of
the diagnosing professional (s).
Thank you
for taking the time to provide the information requested.
If you have questions regarding this form please call OSSD at
the above number.
Return
this information marked confidential to:
Director,
The Office
of Support for Students with Disabilities
University
of Southern Maine
P.O. Box
9300
Portland,
Maine 04104-9300
Note:
This information is kept confidential except as required by
law.
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