Get Columbia Health Verification Of Disability Form For Medical Providers 2013-2025

This guide provides clear, step-by-step instructions on how to complete the Columbia Health Verification Of Disability Form For Medical Providers online. By following these instructions, medical providers can ensure they accurately fill out the necessary information to assist students with disabilities in obtaining needed accommodations.

Follow the steps to successfully complete the form.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering the student's name in the designated field at the top of the form.
3. Fill in the dates of treatment with the current provider or facility to establish the duration of care.
4. Provide the date the student was last seen for a consultation or evaluation.
5. Document the medical diagnosis or diagnoses the student is currently facing.
6. Specify the onset date of the condition(s) to provide context regarding the timeline.
7. Indicate the current status of the condition(s), such as whether it is active, progressing, controlled, or in remission.
8. Estimate how long the condition(s) are likely to persist, offering details like ‘lifetime,’ ‘one academic year,’ or similar time frames.
9. List the current functional limitations of the student in detail, specifying areas such as ambulation, upper extremity motor function, hearing, vision, and cognitive processes.
10. Rate the severity of the student's functional limitations both with and without mitigation measures in the designated sections.
11. Describe specific factors that may exacerbate the identified disabilities.
12. List any medications the student is currently taking, including dosages and frequencies, and describe their effects.
13. Explain how the student’s condition impacts their ability to attend classes or live in University housing.
14. Detail how the student's condition affects their overall learning and cognitive abilities.
15. Identify potential accommodations necessary for the student to participate in University programs and activities.
16. Specify the anticipated duration of the need for these accommodations.
17. Complete the medical professional's name, license number, the state, address, and telephone number.
18. Ensure the medical professional signs the document, confirming they are not related to the student by blood or marriage.
19. Finally, save changes, download, print, or share the completed form as required.

Take the next step in supporting students by completing the Columbia Health Verification Of Disability Form online today.