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: 768–0943 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:
- Intelligence Testing ___X____
- Academic Testing ___X___
- Medical Evaluation ____X____
- Speech Language Evaluation _______
- Occupational Evaluation ___X____
- Other (Be Specific) _________
- Audiometric Evaluation _______
- Psychiatric Evaluation _______
- Psychological Evaluation ____X___
- Portfolio Assessment ___X____
- Curriculum Based Assessment ___X____
- 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-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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