#504 ACCOMMODATION PLAN FOR DIABETES PDF#

Signature of Patient or Representative Authorized by LawĮmail all the completed forms in pdf format at the same time in one email to.If not the patient, name of person signing form: Date (this date needs to be after the date on the medical form).Request for Accommodation(s) (check all requested).Describe the concern below and how it affects the student's performance at school.Step 2 : 2023-2024 Request for Section 504 Accommodations Form with HIPAA - Completed by a Parent or Guardian All parts of the CONTACT INFORMATION & ATTESTATION.How does this diagnosis affect educational performance? Does the diagnosis have an impact on learning, participation, or attendance in school? If so, please describe.Student’s current clinical status (level of control, current management plan, pending evaluations, etc.).The following fields must be completed on the form for the application to be reviewed: Step 1 : 2023-2024 Medical Accommodations Request Form - Completed by a Medical Provider Parent Request Form with HIPAA (Completed by Parent or Guardian) Medical Accommodations Request Form (Completed by Medical Provider) If any of the required fields listed below are not filled out on the forms, we are not able to move forward.All of the forms need to be filled out every year.All 504 plans terminate at the end of June of each school year, no matter when during the school year the 504 plan went into effect.(For diabetes and medication administration 504 plans, please find the applicable forms here ) Please follow the steps below to submit 504 applications for classroom, building and testing accommodations. Contact the school 504 Coordinator or principal, or email with questions or concerns about a DOE student’s access to a DOE program or activity, or a non-DOE extracurricular program.Ĭhancellor’s Regulation A-830 sets forth the DOE’s anti-discrimination policies and procedures, including complaint procedures, for employees, parents of students, students and others who do business with, use DOE facilities or otherwise interact with the DOE.ĭirect inquiries regarding student Section 504 rights or procedures to: Confidentiality rights of persons with disabilities will be respected.Ĭhancellor’s Regulation A-710 sets forth the DOE policies and procedures, including complaint procedures, for students attending DOE schools and programs who are qualified individuals with disabilities as defined in Section 504 and who are in need of accommodations in order to participate in DOE programs or activities. It is the policy of the New York City Department of Education (DOE) that, in accordance with Section 504 of the Rehabilitation Act of 1973 (Section 504), no otherwise qualified person with a disability shall, solely by reason of their disability, be excluded from or otherwise denied participation in, be denied the benefits of, or be subject to discrimination under any program or activity sponsored by the DOE. P/SAT Day Technology Survey (Grades 10 & 11).Rising Stars Tickets, Parents Association.Studio: Music (Instrumental and Vocal Music Programs).Morningside Center for Teaching Social Responsibility.504 Accommodation Plans / Testing Accommodations.

504 accommodation plan for diabetes