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1342.12 Companion
July 12, 2017
Page 55
Other Health Impairment Eligibility Guide
"Other Health Impairment" means limited strength, vitality, or alertness including a heightened
alertness to environmental stimuli that result in limited alertness, with respect to the educational
environment, that is due to chronic or acute health problems and that adversely affects a student’s
educational performance. Such impairments may include, but are not necessarily limited to, attention
deficit disorder, attention deficit hyperactivity disorder, heart condition, tuberculosis, rheumatic fever,
nephritis, asthma, sickle cell anemia, hemophilia, seizure disorder, lead poisoning, leukemia, or diabetes.
Required Assessments
Observation; review of existing school educational and health records; for ADHD, a social maturity index
or behavior rating scales; educational impact analysis.
The CSC must gather the necessary information to meet the eligibility criteria.
Recommended Assessments to assist the CSC to meet eligibility criteria
Formal and/or informal measures of academic achievement supported by teacher reports, group
achievement test scores, report cards, etc. After review of all records, the CSC determines if there is a
need to obtain additional assessments (e.g. medical, developmental history, cognitive, language).
Criteria
There is documentation of an identified Other Health Impairment and it impacts the student in the area
of (check all that apply):
☐
Strength (physical energy and endurance level in school)
☐
Vitality (emotional and mental energy and endurance level in school)
☐
Alertness (including heightened alertness to environmental stimuli, which result in limited
alertness with respect to the educational environment)
Indicate chronic or acute health condition:
☐
Asthma
☐
Diabetes
☐
Hemophilia
☐
Nephritis
☐
Tourette syndrome
☐
Attention deficit disorder or
attention deficit hyperactivity
disorder
☐
Epilepsy
☐
Lead poisoning
☐
Rheumatic fever
☐
Heart condition
☐
Leukemia
☐
Sickle cell anemia
☐
Other (describe):
The CSC will list and/or describe the identified impairment and areas of impact.
AND
Due to the identified Other Health Impairment, the student is educationally impacted and requires
specially designed instruction. The CSC will list and/or describe the effect on educational performance.