Documentation & Forms

If you are being evaluated for a suspected disability or reevaluated for a preexisting disability, please submit a copy of the appropriate set of guidelines along with the Disabilities Intake Form to your evaluator.*

All disability documentation must meet the criteria described in the guidelines, and new reports should use the appropriate forms if possible. Please note that the form for learning disabilities and attention deficit disorder is a cover sheet only. These diagnosticians typically use their own preferred formats for the full report. If you have questions, please feel free to contact the Office of Disability Support Services at (315) 464-8855.

*Please note that appropriate documentation is needed for each disabling condition declared.

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Learning Disability Accommodation

Note: There is a specific form related to Learning Disability that must be completed and submitted to our office before we can consider accommodation requests

A Qualified Professional Must Conduct the Evaluation

  • Name, title, professional credentials, licensure/certification information, and location of practice must be included on any reports submitted.
  • Evaluators must have training in, and experience with, evaluating learning disabilities in adolescents and/or adults.
  • Appropriate professionals may include neuropsychologists, clinical psychologists, educational psychologists, school psychologists, and psychiatrists. Learning disability specialists (and others) may be part of a diagnostic team, though they are not generally recognized as primary evaluators for post-secondary students.
  • Evaluations performed by members of the students family are not acceptable.
  • All reports must be signed by the primary evaluator and should include a completed Upstate Medical University form (cover sheet) if feasible. Note: Evaluator must also number and initial each page of the evaluation.

Documentation Must Be Current

  • Reports should, in general, be based on evaluations performed within three years and reflecting adult norms.
  • Reports should describe the current impact of the diagnosed condition.
  • Reports should make recommendations appropriate to a postsecondary setting, preferably a medical school environment.

Documentation Must Be Comprehensive

  • Reports should include a history (medical, developmental, academic, familial), and indicate evidence of early impairment, even if not formally diagnosed in childhood or early adolescence.
  • Reports should indicate evidence of current impairment, including the results of a diagnostic interview and a battery of psycho-educational tests designed to identify learning disabilities.
  • Minimally, testing must include a) assessment of cognitive ability/intellectual functioning, b) measurement of academic achievement, c) instruments that measure various domains of information processing, d) other instruments to help rule in or rule out the diagnosis of learning disability.
  • A specific diagnosis must be included if indicated. If the evaluation does not clearly indicate the existence of a learning disability, the examiner must state that fact.
  • All test scores should be included, along with an interpretation of each and a summary.
  • Documentation should rule out alternative explanations for learning problems (i.e. difficulties that are motivational, emotional, attention-related, or related to limited fluency in the English language.)
  • Documentation should address any coexisting disorders or suspected coexisting disorders.
  • Documentation must indicate whether or not the evaluator believes the diagnosed condition rises to the level of a disability as defined by Section 504 and the ADA (i.e. substantially limiting a major life activity). This professional opinion should then be explained.
  • Relevant academic history including results of prior standardized testing, reports of classroom performance and behaviors including transcripts, study habits and attitudes and notable trends in academic performance.
  • A clear indication of the student's functional limitations must be included.
  • Documentation should include recommendations for accommodation that are directly related to the designated functional limitations.
  • If no prior accommodations have been provided, the qualified professional expert should include a detailed explanation as to why no accommodations were given in the past and why accommodations are needed now.
  • A rationale, explaining why each recommendation for accommodation is appropriate, should be given.

Adapted from: Learning and Disability Services, Dartmouth Medical School

Psychiatric Disabilities

Note: There is a specific form related to Psychiatric Disabilities that must be completed and submitted to our office before we can consider accommodation requests.

A Qualified Professional Must Conduct the Evaluation

  • Name, title, professional credentials, licensure/certification information, and location of practice must be included on any reports submitted.
  • Evaluators must have training in, and experience with, the differential diagnosis of psychiatric disorders in adolescents and/or adults.
  • Appropriate professionals may include clinical psychologists, neuropsychologists, psychiatrists or other specifically trained medical doctors, clinical social workers, licensed mental health counselors, and psychiatric nurse practitioners.
  • Evaluations performed by members of the students family are not acceptable.
  • All reports must be signed by the evaluator, and should include a completed Upstate Medical University form (if feasible), as well as any additional information typed on letterhead. Note: Evaluator must also number and initial each page of the evaluation.

Documentation Must Be Current

  • Initial documentation should, in general, be based on evaluations performed within six months.
  • If a report is older than six months, and the student has remained in clinical contact with his or her evaluator, that professional may supplement the original report with a letter (on letterhead) describing any and all changes since the previous report. [The supplement would be in lieu of another complete report.]
  • The timing of follow-up, supplemental documentation is typically based on the professional's recommendation, and is usually required every 3, 6, or 12 months.
  • All documentation (including any supplements), should describe the current impact of the diagnosed condition(s).
  • All documentation should describe any currently mitigating factors, such as medication or other treatment.
  • All documentation should make recommendations currently appropriate to a medical school environment.

Documentation Must Be Comprehensive

  • Reports should include a brief history of the students psychiatric problems, and must include any prior behavior that was violent or destructive.
  • A specific diagnosis, or more than one, must be included.
  • Reports must indicate that DSM-IV or DSM-V criteria have been met for each condition.
  • Other potential diagnoses must be ruled out in the report.
  • Documentation must indicate whether or not the evaluator believes the diagnosed condition(s) rise(s) to the level of a disability as defined by Section 504 and the ADA (substantially limiting a major life activity).
  • There must be a clear indication of the individual students functional limitations, in a medical school environment and across other domains.
  • Documentation should include recommendations for accommodations that are directly related to the functional limitations.
  • If no prior accommodations have been provided, the qualified professional expert should include a detailed explanation as to why no accommodations were given in the past and why accommodations are needed now.
  • A rationale, explaining why each recommendation for accommodation is appropriate, should be given.
  • A statement regarding potential for harm to self or others must be included.
  • A clinical summary is helpful.

Adapted from: Learning and Disability Services, Dartmouth Medical School

Attention Deficit / Hyperactivity Disorder (ADHD)

Note: There is a specific form related to Attention Deficit/
Hyperactivity Disorder (ADHD) that must be completed and submitted to our office before we can consider accommodation requests.

A Qualified Professional Must Conduct the Evaluation

  • Name, title, professional credentials, licensure/certification information, and location of practice must be included on any reports submitted.
  • Evaluators must have training in, and experience with, the differential diagnosis of ADHD in adolescents and/or adults.
  • Appropriate professionals may include clinical psychologists, neuropsychologists, school psychologists, psychiatrists or other specifically trained medical doctors.
  • Evaluations performed by members of the students family are not acceptable.
  • All reports must be signed by the evaluator, and should include a completed Upstate Medical University form (if feasible), as well as any additional information typed on letterhead.

Documentation Must Be Current

  • Reports should, in general, be based on evaluations performed or updated within three years.
  • Reports should describe the current impact of the diagnosed condition.
  • Reports should mention any currently mitigating factors, such as medication.
  • Reports should make recommendations appropriate to a postsecondary setting, preferably a medical school environment.

Documentation Must Be Comprehensive

  • Reports should include a history (medical, psychosocial, academic, familial), and indicate compelling evidence of early impairment, even if not formally diagnosed in childhood.
  • Reports should indicate evidence of current impairment, including the results of a clinical diagnostic interview and review of any psycho-educational tests performed to investigate the existence of an attention deficit disorder.
  • A specific diagnosis must be included or specifically ruled out.
  • The information collected by the evaluator must consist of more than self-report.
  • Reports including a diagnosis must demonstrate that DSM-IV criteria have been met.
  • Any test scores must be included, along with an interpretation of each and a summary.
  • Documentation should rule out alternative diagnoses and/or explanations for problems.
  • Documentation should address any coexisting disorders, suspected coexisting disorders, or other confounding factors.
  • Documentation must indicate whether or not the diagnosed condition rises to the level of a disability as defined by Section 504 and the ADA (substantially limiting a major life activity).
  • There must be a clear indication of the individual students functional limitations.
  • Documentation should include recommendations for accommodations that are directly related to functional limitations and relevant to a medical school environment if possible.
  • If no prior accommodations have been provided, the qualified professional expert should include a detailed explanation as to why no accommodations were given in the past and why accommodations are needed now.
  • A rationale, explaining why each recommendation for accommodation is appropriate, should be given.

Adapted from Learning and Disability Services, Dartmouth Medical School

Physical / Sensory Disabilities

Note: There is a specific form related to Physical/Sensory Disabilities that must be completed and submitted to our office before we can consider accommodation requests.

A Qualified Professional Must Conduct the Evaluation

  • Name, title, professional credentials, licensure/certification information, and location of practice must be included on any reports submitted.
  • Evaluators must have training in, and experience with, the diagnosis of like or similar conditions in adults.
  • Appropriate professionals are usually licensed physicians, often with specialty training. Optometrists are appropriate for visual conditions addressed in their training. Allied health professionals (such as audiologists, neuropsychologists, or physical therapists) may be considered appropriate as well, often as part of a team.
  • Evaluations performed by members of the students family are not acceptable.
  • All reports must be signed by the primary evaluator, and should include a completed Upstate Medical University form (if feasible), as well as any additional information typed on letterhead. Note: Evaluator must also number and initial each page of the evaluation.

Documentation Must Be Current

  • Reports should be based on evaluations performed within a reasonable time frame, depending on the degree of change associated with the diagnosed condition(s). Generally a reasonable time frame is not more than three years, but it may be much shorter in many instances.
  • Reports should accurately describe the current impact of the diagnosed condition.
  • Reports should indicate the currently anticipated course of the condition.
  • Reports should mention any currently mitigating factors (e.g. medication or hearing aids).

Documentation Must Be Comprehensive

  • Reports should include a history.
  • Reports should include both description and evidence of impairment.
  • Reports should briefly describe any current treatment plan.
  • A specific diagnosis (or more than one) must be included.
  • Documentation should address any coexisting conditions, suspected coexisting conditions, or other confounding factors.
  • Documentation must indicate whether or not the diagnosed condition(s) rises to the level of a disability as defined by Section 504 of the Rehabilitation Act and the ADA (substantially limiting a major life activity).
  • There must be a clear indication of the individual students functional limitations.
  • Documentation should include recommendations for accommodations that are directly related to the functional limitations (and relevant to a medical school environment if possible.)
  • If no prior accommodations have been provided, the qualified professional expert should include a detailed explanation as to why no accommodations were given in the past and why accommodations are needed now.
  • A rationale, explaining why each recommendation for accommodation is appropriate, should be provided.
  • If the student is considered a potential danger to self or others, including patients under his or her care, that information must be included. If there are only certain circumstances under which a potential danger exists, that should be explained as well.

Adapted from: Learning and Disability Services, Dartmouth Medical School

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