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ORIENTATION AND MOBILITY CHECKLIST MULTI IMPAIRED SEVERE AND PROFOUND DATE: STUDENT: O&M SPECIALIST: TV: Does the student have vision? Visual Acuity Does the Student: Travel independently: yes no
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To fill out the deaf-blindness and visual impairment forms, follow these steps:
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Start by gathering all the necessary information about the individual who has deaf-blindness or visual impairment.
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Begin with the personal details, such as name, date of birth, and contact information.
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Provide a brief overview of the medical history and any relevant diagnoses or conditions.
05
Describe the specific disabilities experienced by the individual, including the severity and impact on daily life.
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Include any assistive devices or technologies used to aid in communication or mobility.
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Detail the educational and vocational history, including any special accommodations or services received.
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Explain any additional support or services required, such as therapy, counseling, or accessibility modifications.
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Finally, review the form for accuracy and completeness before submitting it to the appropriate authority.
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Note: It is recommended to consult with healthcare professionals or disability specialists for assistance in accurately filling out these forms.

Who needs deaf-blindness and visual impairment?

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Deaf-blindness and visual impairment forms are necessary for individuals who have the following conditions:
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- Deaf-blindness: Individuals who experience significant combined visual and hearing impairments that cause extreme difficulties in acquiring information, communication, and performing daily activities.
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- Visual impairment: Individuals with a significant loss of vision that cannot be fully corrected with glasses, contact lenses, or other standard treatments. This includes individuals who are blind or have low vision.
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These forms are typically required for accessing specialized services, accommodations, or support for individuals with deaf-blindness or visual impairment.
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Deaf-blindness refers to a combination of hearing and vision loss that affects communication, access to information, and mobility. Visual impairment refers to a decrease in the ability to see clearly.
Individuals who have been diagnosed with deaf-blindness or visual impairment are required to report their condition.
Individuals can fill out deaf-blindness and visual impairment forms provided by the relevant authorities and submit medical documentation supporting their diagnosis.
The purpose of reporting deaf-blindness and visual impairment is to ensure that individuals with these conditions receive appropriate accommodations and support.
Individuals must report their diagnosis, date of diagnosis, and any supporting medical documentation.
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