Follow the steps to successfully complete the documentation process.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Provide the student’s full name including first name, middle initial, and last name in the designated field.
3. Enter the DSM-IV diagnosis in the specified section.
4. Indicate when the diagnosis was made by filling in the date in the appropriate box.
5. Record the last date of contact with the student in the next available field.
6. List any instruments or procedures that were utilized to arrive at the diagnosis.
7. If applicable, indicate the level of severity by marking the corresponding option: Mild, Moderate, or Severe.
8. If the student is currently taking medications related to the condition, please provide the names of those medications.
9. Briefly summarize the current treatment plan, if one exists, in the specified area.
10. Describe the functional limitations that the student faces due to the condition, detailing how these may affect academic activities such as reading, writing, note-taking, concentration, studying, and interactions.
11. Suggest accommodations that may be beneficial for the student based on the described limitations.
12. Sign the document in the designated signature field.
13. Fill in the professional license number and print or type your name and title.
14. Provide your address and phone number in the respective fields.
15. Add the date of completion in the last provided field.
16. Once the form is fully completed, you can choose to save changes, download it, print a copy, or share it as needed.

Take the next step in your academic journey by completing the documentation online.