Get Adhd Verification Form - Disability Services - Disability Columbusstate

Completing the ADHD Verification Form is an essential step for individuals seeking academic accommodations due to Attention-Deficit/Hyperactivity Disorder. This guide provides clear instructions on filling out the form accurately to ensure a smooth submission process.

Follow the steps to accurately complete the ADHD Verification Form.

1. Click ‘Get Form’ button to obtain the ADHD Verification Form and open it for editing.
2. Begin with the student information section. Enter your full name (last, first, middle), date of birth, and status as either a current student, transfer student, or prospective student. Provide your institution name, local phone number, cell phone number, address, and email address.
3. Move to the diagnostic information section, which must be filled out by your healthcare provider. Ensure they provide a DSM-IV diagnosis and details such as the date of first contact, date of diagnosis, and any comorbid conditions.
4. In the student's history subsection, your provider should detail past evidence of symptoms, relevant medical history, and medication, if prescribed.
5. Your healthcare provider needs to indicate the current ADHD symptoms by checking the appropriate boxes listed under inattention, hyperactivity, and impulsivity.
6. The healthcare provider should state the functional limitations experienced in an educational setting due to ADHD.
7. Recommendations for academic accommodations should be included, with justifications based on the identified functional limitations.
8. Document impairment in two settings by independent observers, and attach rating scales for retrospective childhood and current adult behavior as needed.
9. Have the healthcare provider fill out and sign the healthcare provider information section, including their name, title, license or certification number, address, and phone number.
10. After completing all sections, ensure the form is clear and legible. Save your changes, download a copy, and print if necessary. Share the completed form with the Disability Services Provider at your institution.

Complete and submit the ADHD Verification Form online to facilitate your request for academic accommodations.