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This form is used to gather information from a physician regarding a student's physical or mental impairments that may qualify them for protection under Section 504 of the Rehabilitation Act. It includes
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How to fill out section 504 physician questionnaire
How to fill out SECTION 504 PHYSICIAN QUESTIONNAIRE
01
Begin by filling in the patient's personal information at the top of the questionnaire, including their name, date of birth, and contact details.
02
Indicate the patient's disability or medical condition clearly in the designated section.
03
Provide detailed information about the medical diagnosis, including relevant medical history and the impact of the condition on the patient's daily activities.
04
Answer specific questions regarding the functional limitations caused by the condition and how it affects the patient's ability to perform in a school or work environment.
05
Include any recommendations for accommodations or modifications that the patient may require to support their needs.
06
Sign and date the questionnaire to verify that the information provided is accurate and complete.
Who needs SECTION 504 PHYSICIAN QUESTIONNAIRE?
01
Students with disabilities requiring special accommodations in school settings.
02
Individuals applying for services or benefits under Section 504 of the Rehabilitation Act.
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What is SECTION 504 PHYSICIAN QUESTIONNAIRE?
The SECTION 504 PHYSICIAN QUESTIONNAIRE is a form used to gather medical information about an individual to assess their eligibility for accommodations under Section 504 of the Rehabilitation Act of 1973, which aims to protect the rights of individuals with disabilities.
Who is required to file SECTION 504 PHYSICIAN QUESTIONNAIRE?
Typically, it is required that the parents or guardians of students who have been identified as having a disability file the SECTION 504 PHYSICIAN QUESTIONNAIRE, along with the physician or medical provider who is familiar with the individual's condition.
How to fill out SECTION 504 PHYSICIAN QUESTIONNAIRE?
To fill out the SECTION 504 PHYSICIAN QUESTIONNAIRE, a physician or qualified medical provider should complete the form by providing detailed information about the individual's medical condition, functional limitations, and any recommended accommodations or services that may be necessary.
What is the purpose of SECTION 504 PHYSICIAN QUESTIONNAIRE?
The purpose of the SECTION 504 PHYSICIAN QUESTIONNAIRE is to collect relevant medical and functional information that helps educational institutions determine the eligibility of students for Section 504 accommodations and to ensure their needs are met in an educational setting.
What information must be reported on SECTION 504 PHYSICIAN QUESTIONNAIRE?
The SECTION 504 PHYSICIAN QUESTIONNAIRE must report information such as the individual's diagnosed medical condition, specific functional limitations caused by the condition, and any recommendations for accommodations or services needed to support the individual in their educational environment.
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