Other Health Impairment Evaluation Checklist (Medical Conditions)
Document how a chronic or acute health condition affects learning, attendance and stamina at school. A free, fillable checklist for school psychologists and evaluation teams.
What’s inside
- The federal eligibility requirements, each with space to note where the evidence is documented
- 18 commonly used measures to check off, with date tested, examiner and results
- Records, interviews, observations and screenings
- Functional impact at school
- Evaluation timeline and a team summary box
Get it free
Enter your email and confirm it. You’ll go straight to the download, plus all our other free checklists and tools.
What IDEA requires for Other Health Impairment (Medical)
The checklist walks your team through each part of the federal definition so nothing is missed at the eligibility meeting:
- Chronic or acute health problem (e.g., asthma, diabetes, epilepsy, heart condition, sickle cell anemia, Tourette syndrome, leukemia)
- Results in limited strength, vitality or alertness in the educational environment
- Adversely affects educational performance
- Student needs specially designed instruction (if not, consider a Section 504 plan or health plan)
- Medical or physician documentation, if your state requires it
Summary of federal IDEA regulations (34 CFR §300.8(c)(9)). Your state may add criteria or use different terms. Follow state and district procedures.
Measures included in the checklist
No single test determines eligibility. The checklist lists measures school psychologists commonly use so you can document what was given, when and by whom:
- Health information: Physician statement / medical records (with consent), School nurse health assessment, Individualized health plan (IHP) / emergency plan, Medication list and side effects, Attendance and health-related absences
- Cognitive and neurocognitive: WISC-V (or WPPSI-IV / WAIS), NEPSY-II (selected subtests), WRAML3 (memory), Processing speed and fatigue observations
- Achievement: WIAT-4 or KTEA-3, Curriculum-based measures, Grades and work completion
- Behavior, social-emotional and adaptive: BASC-3 (parent / teacher / self), Adaptive measure if needed (Vineland-3 or ABAS-3), Classroom observation (stamina, alertness)
- Related services: Occupational therapy evaluation, Physical therapy evaluation, Speech-language evaluation
Blank rows let you add any other measures your team uses.
Functional impact at school
- Stamina and fatigue across the day
- Missed instruction from absences or appointments
- Medication or treatment effects on attention and memory
- Physical access and safety needs
- Emotional impact and peer relationships
- Re-entry plan after hospitalization or long absence
Frequently asked questions
Is the checklist fillable?
Yes. You can type into it on a computer or print it. Check boxes are printed, and every date, examiner and notes field can be filled in digitally.
Does this replace my state or district forms?
No. It is a working checklist to organize data. Your state may add criteria or use different terms, so always follow state and district procedures and use their required forms.
Can I share it with my evaluation team?
Yes. Share it with colleagues on your team. If others want their own copy, send them to this page.