Provider Verification Forms
General Documentation Guidelines
For providers that prefer to submit medical documentation instead of using the provided verification forms, documentation needs to be typed, dated, signed and on letterhead from a qualified, licensed professional that is authorized to evaluate disabilities (e.g., physician, psychiatrist, psychologist, mental health counselor) and is not related/does not have a personal relationship with the individual being evaluated.
Documentation must also include:
- Diagnosed disability or condition (including the specific DSM-V and/or ICD-10 diagnosis). If other criteria were used to arrive at the diagnosis, please detail those as well.
- Date of the initial diagnosis and the date of the most recent visit with the student regarding this diagnosis.
- Length of time the student has been under provider’s care.
- Describe the current functional limitations resulting from the disability or condition (i.e., provide specific, real-world impacts the diagnosis has on the student’s ability to perform routine daily activities in the educational setting).
- How the diagnosis or disability affects the student’s learning or other major life activities (e.g., concentrating, learning, reading, writing, mobility, care for oneself, sleep, etc.)
- Current medications (if applicable), the type of medication(s), side effects or impacts of the medication(s), the impact on the student’s ability to meet the demands of the postsecondary environment, and if symptoms persist with use.
- Current symptoms and how they might affect the student’s ability to access RMC’s academic opportunities, facilities or programming. Please include severity and/or frequency of symptoms and any variability in functioning (e.g., episodic, fluctuating, or situational).
- The student’s prognosis, including how long the provider anticipates the student’s ability to access RMC’s academic opportunities, facilities and/or programming to be impacted by the disability/condition.
- The severity, duration, and frequency of disabilities that include flare-ups and intermittent symptoms (if applicable).
- Provide recommendations for accommodations or services that the student may need.
Learn more about the Essential Elements of Quality Documentation.
For Housing/Dining Requests
In addition to the applicable general guidelines, medical documentation should:
- Specify the requested accommodation to ensure equal access to university housing or dining.
- Detail how the student’s medical or psychiatric condition necessitates the requested housing or dining accommodation.
- Include foods that the student should consume and/or avoid that support relative to the dining or housing request (if applicable).
- Demonstrate how the room configuration or specific environmental features will help alleviate the student’s symptoms.
- Detail how the housing or dining request is essential for equal access to the campus environment due to a disability.
For Emotional Support Animals (ESAs)
Medical documentation should include:
- Confirmation of a diagnosis
- Details related to the functional impact or limitations resulting from your disability.
- Information about how an ESA is a necessary component of your treatment plan and how it alleviates the impact of a disability or reduces the impact of a specific set of symptoms.
Other Forms of Documentation
IEPs, learning profiles or 504 plans are acceptable forms of documentation, but if the documentation provided does not clearly substantiate a need for the requested accommodation, further evaluation or additional documentation may still be needed to determine reasonable accommodations. Documentation is discussed during the Initial Meeting after submission of the accommodation request form in the Accessibility Resources Online Portal. Please contact Accessibility Resources at accessibility@rmc.edu if you have any questions.
How to Submit Documentation
Please submit any disability documentation or other relevant documents electronically to Accessibility Resources via the Academic Accommodations Application on the Disability Services Online (DSO) portal (preferred for unregistered students) or email to: accessibility@rmc.edu. Students also have the option of providing disability documentation via fax: (804) 752-3744, mail: P.O. Box 5005; Ashland, Va., 23005, or in-person during normal business hours. We are located in the Higgins Academic Center, McGraw Page Library. All records kept by AR are systematically destroyed after 5 years unless the student is still enrolled at the College. Students should keep the original copy of their documentation.
Documentation Guidelines by Category
Attention Deficit Hyperactivity Disorder (ADHD)
Documentation should include a Psychological Evaluation conducted by a licensed psychologist, or the following information if an evaluation is not available:
- A clear diagnosis made by the evaluator based on the evaluation (not purely based on historical report of a previous diagnosis)
- Date(s) of evaluation
- Assessments used to determine diagnosis along with test scores and/or percentiles.
- Provide a summary of the student’s educational or medical history that may relate to the ADD/ADHD diagnosis. This description should provide information regarding onset, longevity, and severity of symptoms, as well as specifics related to how it has interfered with educational achievement.
- A statement of the functional impact or limitations on learning or other major life activities and the degree to which it impacts the individual in the learning context for which accommodations are being requested.
- A clear statement of specific recommendations, modifications or accommodations relative to the disability.
Specific Learning Disability
Documentation should include a Psychological Evaluation conducted by a licensed psychologist, or the following information if an evaluation is not available:
- A clear diagnosis made by the evaluator based on the evaluation (not purely based on historical report of a previous diagnosis)
- Date(s) of evaluation
- Assessments used to determine diagnosis along with test scores and/or percentiles.
- Provide a summary of the student’s educational or medical history that may relate to the SLD diagnosis. This description should provide information regarding onset, longevity, and severity of symptoms, as well as specifics related to how it has interfered with educational achievement.
- A statement of the functional impact or limitations on learning or other major life activities and the degree to which it impacts the individual in the learning context for which accommodations are being requested.
- A clear statement of specific recommendations, modifications or accommodations relative to the disability.
Blindness/Low Vision
Documentation should include:
- Diagnosed disability or condition
- The type and degree/intensity of vision loss
- A description of the permanence/transience/likely progression of vision loss
- A description of the impact of the diagnosis on the student’s everyday life
- Information on any technologies/supports used to aid everyday functioning
Deafness and/or Hard of Hearing
Documentation should include:
- Diagnosed disability or condition
- The type and degree/intensity of hearing loss
- A discussion of the permanence/transience/likely progression of hearing loss
- A description of the impact of the diagnosis on the student’s everyday life
- Information on any technologies/supports used to aid everyday functioning (hearing aids, cochlear implant, ASL, assistive listening systems, etc.)
Medical/Chronic/ Limited Mobility Conditions
In addition to the applicable general guidelines, medical documentation should:
- A clear statement of the medical diagnosis or condition
- A discussion of the permanence/transience/likely progression of the student’s condition
- A description of the impact of the diagnosis on the student’s everyday life in the area(s) of concern, including any patterns in symptoms/presentation
- Information on any technologies/supports used to aid everyday functioning (insulin pump, inhaler, medication injections, wheelchair, specialized keyboard, etc.)
Psychological Conditions/Diagnosis
Documentation should include:
- A clear diagnosis made by the provider
- The length of time the provider has known the student and/or the number of times the provider has interacted with the student
- A description of the treating relationship between the provider and student
- The means/information used to make the diagnosis
- Discussion of additional conditions, if applicable
- provide information regarding onset, longevity, and severity of symptoms, as well as specifics related to how it has interfered with educational achievement.
- A description of the impact of the diagnosis on the student’s everyday life in the area(s) of concern, including any patterns in symptoms/presentation
