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<div>The message below is being sent to you on behalf of:</div>
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<div>Sarah Drinkwater, Ph.D.</div>
<div>Assistant Superintendent</div>
<div>Office of Learning/Student Services</div>
<div>______________________________________________ </div>
<div>May 7, 2014</div>
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<div><b>The Medical Statement or Health Assessment Statement </b>form was revised in March 2014, along with instructions for completing the form. The Medical Statement or Health Assessment Statement form and instructions were initially revised in November,
2013. The November, 2013 revision was made to make both the Medical Statement or Health Assessment Statement form and the accompanying directions more clear, concise, and understandable for school staff and medical providers.</div>
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<div>This recent revision was necessary to make corrections to ensure consistency with OAR 581-015-2150 for Hearing Impairment eligibility. Both documents are located at the following locations on the ODE website: <i>School Age Sample Forms Page </i><a href="http://www.ode.state.or.us/search/page/?id=817%20%20%20"><font color="blue"><i><u>http://www.ode.state.or.us/search/page/?id=817
</u></i></font></a><i> EI/ECSE Evaluation Forms and Medical Statements Page </i><a href="http://www.ode.state.or.us/search/page/?=3166"><font color="blue"><i><u>http://www.ode.state.or.us/search/page/?=3166 </u></i></font></a></div>
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<div>If you have questions regarding the form or the form directions please contact Martha Buenrostro at <a href="mailto:Martha.buenrostro@state.or.us"><font color="blue"><u>Martha.buenrostro@state.or.us</u></font></a> 503-947-5611 or Lisa Darnold at <a href="mailto:lisa.darnold@state.or.us"><font color="blue"><u>lisa.darnold@state.or.us</u></font></a>
503-947-5786.</div>
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<div><font face="Calibri" size="2"><span style="font-size:10pt;"><b><i>Ruby Sandberg, Executive Assistant </i></b></span></font></div>
<div><font face="Calibri" size="2"><span style="font-size:9pt;"><i>Oregon Department of Education</i></span></font></div>
<div><font face="Calibri" size="2"><span style="font-size:9pt;"><i>Office of Learning l Student Services </i></span></font></div>
<div><font face="Calibri" size="2"><span style="font-size:9pt;"><i>503-947-5738 l FAX: 503-378-5156 l </i><a href="mailto:ruby.sandberg@state.or.us"><font color="blue"><i><u>ruby.sandberg@state.or.us</u></i></font></a></span></font></div>
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<div><font face="Calibri" size="2"><span style="font-size:9pt;"><i>The Oregon Department of Education is an equal opportunity agency and employer.</i></span></font></div>
<div><font face="Calibri" size="2"><span style="font-size:9pt;"><i>Messages to and from this email address may be made available to the public under Oregon law.</i></span></font></div>
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