Craigslea State High School

Access Arrangements and Reasonable Adjustments (AARA)

Principal Approved Application

Confidential Medical Report

Medical reports may only be completed by the student’s general practitioner (GP) or a medical specialist (registered under Queensland’s Medical Practitioners Registration Act 2001). The health professional providing a report must not be related to the student or employed by the school. The information provided needs to be current and relate to the relevant assessment period.

Information provided in this report is treated is strictest confidence and is only used for the purpose of determining the student’s AARA application.

If the health professional does not use this report form, they must supply a current medical report containing all of the following information.

Student Details
Name:
School:
LUI:
I give permission for my health professional to provide information concerning this application to the QCAA, if required.
Student Signature	Date
Parent/carer Signature (if student is under 18)	Date

This section is to be completed by the health professional.

Diagnosis:
Date of diagnosis:
Date of occurrence/onset:

This section is to be completed by the health professional.

I consider that the effect of the impairment arising from the medical condition is/was:
mild	moderate	severe
I consider that the student is/was:
disadvantaged due to temporary medical condition
unfit to participate in assessment due to a temporary medical condition from ___/____/____ (date) to ___/____/____ (date).
unfit to participate in assessment due to a deterioration in a chronic condition from ___/____/____ (date) to ___/____/____ (date).
If the student was affected for less than a full day, comment on the amount of time the student was affected during a timed assessment, e.g. second half of the exam session.
Professional recommendations for assessment adjustments.

Health professional details

Name:
Profession:
Phone:
Specialty/qualifications: (if applicable)
Place of work:
Registration number:
Practice stamp: (if applicable)

Signature: ___________________________	Date: ________________________