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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:
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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;
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has a record of such an impairment; or,
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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.
Send 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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