Disability ServicesHealth Practitioner Report

Please return this form to Student Wellbeing reception, email to , or bring to the appointment with a Disability Adviser.

The University provides support services and reasonable academic accommodation for students with a disability, injury or health condition. The aim is to reduce the impact of these conditions on the student’s study.

To assist the University in determining the most appropriate support for the student, an assessment of their needs is required.

Authority to release information

I / give authority for

(Student Name) (Health Practitioner Name)

to release information relating to my disability or health condition to the Disability Service at the University of the Sunshine Coast.

Student’s signature: / Date:

Disclosure of information is voluntary. The information you provide is treated as private and confidential. No information is released without your written consent, except where required or authorised by law, for example if the staff member believes that you or others may be at risk.

Health Practitioner to complete this section or attach relevant documentation

Name:
Profession:
Phone:
Email:
Signature:
Date:


To be completed by the Health Practitioner in accordance with USC documentation requirements (see attached).

Information about disability

Diagnosis (Note: If you were not the Health Practitioner who made the diagnosis, please ensure you have sighted the original diagnostic assessment report):
Date of diagnosis:
Further relevant details (e.g. temporary / ongoing, condition to be reviewed, risk factors, management information, medication):

Functional implications on student’s study

Please describe how this condition could affect the student’s functioning in an academic setting, based on your assessment, e.g. reading, writing, cognitive skills, mobility, attendance, access:
Please indicate if any specific adaptive equipment / software / furniture has been prescribed:

Recommended strategies to assist the student

☐ Access to Respite Room – student does not require medical supervision

☐ Extra time during exams ☐ Flexible exam scheduling ☐ Use of a computer / software for exams

☐ Other:

STUDENT WELLBEING
focus balance thrive /