Criteria for Documentation for Psychiatric/Mental Health Impairments
- Student Name
- Social Security Number
- Date of Birth
- Date of evaluation
- DSM diagnosis
- Describe pertinent history
- Summary of present symptoms
- Describe what assessment procedures were used
- Is the impairment stabilized? What is the prognosis?
- Describe the functional nature of the impairment
- Describe current medications and possible side effects
- Is the student stabilized on the medication?
- Are there crisis episodes associated with the impairment?
- Describe the student’s functional limitations in an educational setting.
- Do you have any recommendations regarding academic accommodations for this student?
- Name, signature, and title of evaluator
- Date