Get Psychiatric Condition/disability Documentation Form - Rush University - Rushu Rush

Completing the Psychiatric Condition/Disability Documentation Form is an essential step for students seeking accommodations for psychiatric conditions at Rush University. This guide provides a clear and supportive pathway to effectively fill out the form online, ensuring all necessary information is accurately recorded.

Follow the steps to successfully fill out the form online:

1. Press the ‘Get Form’ button to access the form and open it in the appropriate editor.
2. Begin filling out the student information section. Provide the student's last name, first name, middle initial (MI), date of birth, address, and phone number.
3. Next, locate the certifying mental health professional section. Here, you will input their name, professional title, phone number, address, highest degree earned, email, licensing credential, number, and state.
4. Record the relevant dates, including the report date, date of first student contact, and date of last student contact.
5. For the DSM IV diagnosis section, detail the applicable diagnoses under Axis I, Axis II, and Axis V as appropriate.
6. Indicate whether any of the diagnosed conditions substantially limit a major life activity. If yes, specify which conditions and the corresponding major life activities.
7. Provide a brief history, including the onset of symptoms, any hospitalizations, relevant family history, and prior accommodations that may be pertinent.
8. Outline the symptoms that limit functioning, specifying the degree of limitation for each (mild, moderate, severe).
9. State whether recommended accommodations in school are necessary. If yes, specify the accommodations and provide a rationale for each.
10. Address the medication and treatment section by indicating if the student is taking any medications or requires treatments that may adversely affect performance. If yes, list these and explain their effects.
11. Assess and indicate current compliance with the treatment plan on the provided scale of poor, good, excellent, unknown, or N/A.
12. Provide an evaluation of the current prognosis for the student to function effectively in a professional school setting.
13. Add any additional clinical commentary that may be relevant.
14. Indicate how often the student should be reevaluated (3 months, 6 months, 1 year, or other) and specify if necessary.
15. Evaluate safety concerns by indicating if the individual represents a potential danger to themselves or others. If so, provide further details in the clinical commentary or on attached letterhead.
16. Finally, ensure the certifying mental health professional signs and dates the form.

Complete your documentation online today to ensure appropriate support and accommodations.