Exhibit 5 - Orthopedic Impairment - IEP Format WITHOUT Explanations of the NASET Coding System and Guide Codes

[EXHIBIT 5]

Orthopedic Impairment  

 NASET Coding System and Guide IEP Format WITHOUT Explanations

INDIVIDUAL EDUCATIONAL PROGRAM

School District/Agency:  Lancaster School District

Name and Address:  Lancaster, PA

Section 1- Background Information

Student Name:          Lester Downs

Date of Birth: 2/5/09             Age: 7

Street: 45 Lake Rd.

City:    Lancaster        Zip: 17685

Date of Referral for Committee Review: March 17, 2016
Telephone: 7680943            County of Residence: Lancaster

Male_X_ Female __ Student ID#: 3786T Current Grade: 2
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)-Orthopedic Impairment

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:

  1. Intelligence Testing ___X____
  2. Academic Testing ___X___
  3. Medical Evaluation ____X____
  4. Speech Language Evaluation _______
  5. Occupational Evaluation ___X____
  6. Other (Be Specific) _________
  7. Audiometric Evaluation _______
  8. Psychiatric Evaluation _______
  9. Psychological Evaluation ____X___
  10. Portfolio Assessment ___X____
  11. Curriculum Based Assessment ___X____
  12. Authentic Assessment ___X_____
  13. Task Analysis ____X____
  14. Outcome Based Assessment ________
  15. Learning Styles Assessment _____X______

6.   Committee Recommendations:

Classification (NASET Coding System and Guide Coding):

Level I-Orthopedic Impairment                                                                      OI

Level II-Cerebral Palsy                                                                                   OI 2.00

Level III-Spastic Cerebral Palsy                                                                     OI 2.04

Level IV                                                                                                         Not Applicable

Level V                                                                                                           Severe


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