Get Report Of Medical / Mental Health Condition For ... - Humber College

Filling out the Report of Medical / Mental Health Condition is an essential step for students requesting academic accommodations and support at Humber College. This guide provides clear, step-by-step instructions to help you complete the form accurately and effectively.

Follow the steps to fill out the form online

1. Click ‘Get Form’ button to obtain the document and open it in your editor.
2. In the section labeled 'To Be Completed by the Student', fill in your name, student number, and date of birth clearly in the provided spaces.
3. Complete your address, including street number, city, province, and postal code, in the designated area.
4. Provide your phone numbers and email address to facilitate communication regarding your application.
5. In the 'Student Consent for Release of Information' section, write your name, sign and date the form to authorize your health care practitioner to share necessary information with Disability Services.
6. Hand over the form to your regulated health care practitioner. They will fill out the 'To Be Completed by the Regulated Health Care Practitioner' section.
7. Ensure that they provide a clear diagnosis and describe any primary, secondary, or additional conditions as applicable.
8. Ask the practitioner to specify the date of onset for the primary condition and complete the assessment of the condition's permanence.
9. The health care practitioner should detail the functional impact of your condition on academic performance in the appropriate section.
10. Ensure a treatment plan is outlined, including any medications, their dosages, and possible adverse effects on education.
11. Confirm that the practitioner addresses whether they consider you stable and capable of managing academic stress.
12. Finally, the practitioner must certify their relationship with you, including the duration of care and provide their professional details and signature.
13. Once all sections are complete, save any changes made, then download, print, or share the form as required.

Complete your Report of Medical / Mental Health Condition online to ensure you receive the support you need.