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If condition is episodic in nature level of functioning should be assessed based on active phase of symptoms. The information below is to be completed and signed by the Provider. 1. Please list all DSM-5 or ICD Diagnoses text and code a Date diagnosed / / b Date of your last clinical contact with student 2. Signature Date Print Name and Title State of License License Number Address Street or P. O. Box City State Zip Phone Fax Please return this form signed and sealed to Scottsdale Community...

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What is verification of an autism?

Verification of an autism is a document that confirms a diagnosis of autism spectrum disorder.

Who is required to file verification of an autism?

Parents or legal guardians of children with autism spectrum disorder are required to file verification of an autism.

How to fill out verification of an autism?

Verification of an autism can be filled out by providing the necessary medical and diagnostic information as required by the relevant authorities.

What is the purpose of verification of an autism?

The purpose of verification of an autism is to provide official confirmation of a diagnosis of autism spectrum disorder.

What information must be reported on verification of an autism?

Information regarding the diagnosis, date of diagnosis, and the name of the diagnosing medical professional must be reported on verification of an autism.

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