Exhibit 3 - Emotional Disturbance - IEP Format without Explanations of the NASET Coding System and Guide Codes
[EXHIBIT 3]
Emotional Disturbance
NASET Coding System and Guide IEP Format WITHOUT Explanations
INDIVIDUAL EDUCATIONAL PROGRAM
School District/Agency: Newtown School District
Name and Address: Newtown Province, IL
Section 1- Background Information
Student Name: David Morris
Date of Birth: 2/5/05Age: 11
Street: 14 River Rd.
City: Newtown Zip: 16753
Date of Referral for Committee Review: March 17, 2016
Telephone: 768–0943 County of Residence: Newtown
Male_X_ Female __ Student ID#: 8786Y Current Grade: 5
Dominant Language of Student: English Interpreter Needed: Yes___ No _X__
Medical Alerts: none
Mother’s Name/Guardian’s Name: Mary
Street Address: same
City: same Zip: same
Telephone: same County of Residence:
Dominant Language of Parent/Guardian: English Interpreter Needed: Yes__ No_X_
Father's Name/Guardian's Name: Paul
Street Address: same
City: same Zip: same
Telephone: same County of Residence: same
Dominant Language of Parent/Guardian: English Interpreter Needed: Yes__ No__X_
Section II-Type of Meeting:
A-Initial Evaluation
1. Date of Initial Evaluation Meeting: March 8, 2016
2. Area of Suspected Disability - (NASET Coding System and Guide Level I Diagnosis)-Emotional Disturbance
3. Origin of Evaluation used in determining classification:
- In-school ___X____ Non-school Personnel Evaluation __X___
4. Components of Present Evaluation:
- Individual Standardized Testing _____X____
- Informal Assessment Measures ____X___ (i.e. Portfolio Assessment)
- Observation ___X___
- Social History ___X___
- Teacher Reports ___X___
- Interviews with Child ___X___
- Review of Medical Records ___X____
5. Specific Areas Covered in Evaluation:
- Intelligence Testing ___X____
- Academic Testing ___X___
- Medical Evaluation ____X____
- Speech Language Evaluation _______
- Occupational Evaluation _______
- Other (Be Specific) _________
- Audiometric Evaluation _______
- Psychiatric Evaluation ____X___
- Psychological Evaluation ____X___
- Portfolio Assessment ___X____
- Curriculum Based Assessment _______
- Authentic Assessment ___X_____
- Task Analysis ____X____
- Outcome Based Assessment ________
- Learning Styles Assessment ____X____
6. Committee Recommendations:
Classification (NASET Coding System and Guide Coding):
Level I-Emotional Disturbance ED
Level II-Anxiety Reactive Disorder Code ED 6.00
Level III- School Avoidance Anxiety
Reactive Disorder ED 6.02
Level IV Not Applicable
Level V Moderate
Level I-Emotional Disturbance ED
Level II-Anxiety Reactive Disorder ED 6.00
Level III- Panic Reaction Type ED 6.01
Level IV Not Applicable
Level V- Moderate
Level I-Emotional Disturbance ED
Level II-Inappropriate Behavior or Feelings ED 3.00
Level III-Disruptive Behavior Type ED 3.02
Level IV- Not Applicable
Level V Moderate
Level I-Emotional Disturbance ED
Level II-Relationship Problems Disorder ED 2.00
Level III Not Applicable
Level IV Not Applicable
Level V Moderate
Level I-Emotional Disturbance ED
Level II-Somatic Complaints Disorder ED 5.00
Level III Not applicable
Level IV Not Applicable
Level V Moderate
Note that in the above case the school district also chose to use the five levels of the coding system. The flexibility of this system allows for the district to use as many levels as they see appropriate.
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