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6mY~PL'3Nq;Z;Z76`)ӋyceHSyhҔ|>ƒqI2ZDapvc.{f8Iɋ9H"ߠ_^tsxz#wJ sOo{zXh6bQi("l&~8JD//PW|%'=H!GkyPKLtFlN`G}X*UJﮗô$7ro_c{;2Am@cp0oZ׀@o a,CK!k={ÁNk;>poV3\d{0}>&v_ofJ7ݲΚMe~n9m4kjf٦V5$igݲv $ݲHl9ylC0M;,Aʫ"osU|2y!r~ U6m6k/\r.ߕusU0)QeEEX{"c:?;49)YRJD%1yyܜ%šs6qJ1E%9Mu-C%EًE Cywpaa"_t#KÞwsP;r W&r3mxq8n8XVNic[$*PԤ) zQhtڕ^rC=%\F`:z`;ά]%73Fyp_-UXN\ J2o,LeZ%rmmMP hSh.d}%kʹ̟}=c8q5/VN;ć`kڂڋFCscʡ3Ʀ-T'[օ$p_ڄ`SLnݾ:ukk/זFuu>^i<knAh N@8UVM}j8#DOC=}; XRI D"}VI纟xmbg!fNBs[+g<$DV,;a7- lZ'U~+V- lH}>q\].wS}p'M&$۬9w9 x5c1)]>dS\Nf/.yx{SƏ,K1+hFh(qD4"bYj$#%A"R]P{ 0q3u) _$kmtiVR|thooŨM&Yj5MdC+fq3h8VL:fMM;Yj>Ҵչ7ٝí'!썐F?.*"*иPļ杈n&̯ٗ镮һ\޳/ձ纚<n د2n9$8sM.9WFwUL͹9D#G 9$H.;w?NVQY-%G;=0wp">7͒:hٳ`ɳ6fD&a%>stream Htn Í *V8Nl!ـxH!R>q#Op3ֱj潕Տ*0> 4"3e<{3Q-):\|ݯv3 endstream endobj 183 0 obj <>/ProcSet[/PDF/Text]>>/Rotate 0/StructParents 50/Tabs/S/Type/Page>> endobj 184 0 obj [185 0 R 189 0 R 191 0 R 193 0 R 195 0 R] endobj 185 0 obj <>/DA(/Helv 10 Tf 0 g)/DR<>/Font<>>>/F 4/FT/Tx/MK<<>>/P 183 0 R/Rect[386.04 731.4 593.88 751]/StructParent 203/Subtype/Widget/T(Students Name_2)/TU(Students Name)/Type/Annot/V(The provider signing this form must be the same person answering the questions belowThe provider signing this form must be the same person answering the questions belowThe provider signing this form must be the same person answering the questions belowThe provider signing this form must be the same person answering the questions belowThe provider signing this form must be the same person answering the questions belowThe provider signing this form must be the same person answering the questions below)>> endobj 186 0 obj <>>>/Subtype/Form/Type/XObject>>stream Hn1 {E!)PC)8j;_:tHOC=)dQm;vMwѿCy8͡n7`G!Oy'($RGa/$1a%0s?^^ACV:Ǵ>TEBW!8Zd\|9Qm{*RRM,@_84 dNov3(m-᜽bi(gD11Y]k6 6i_]d5Q]ojY 4LVj6 twKW4ͼ endstream endobj 187 0 obj <> endobj 188 0 obj <> endobj 189 0 obj <>/DA(/Helv 10 Tf 0 g)/DR<>/Font<>>>/F 4/FT/Tx/Ff 4096/P 183 0 R/Rect[27.84 505.52 595.08 638.56]/StructParent 206/Subtype/Widget/T(3a ADHD History Evidence of inattention andor hyperactivity during childhood and presence of symptoms prior to age seven Provide information supporting the diagnosis obtained from the studentparentsand teachers Indicate the ADHD symptoms that were present during early school years eg daydreamer spoke out of turn unable to sit still difficulty following directions etc)/TU(3-a. ADHD History: Evidence of inattention and/or hyperactivity during childhood and presence of symptoms prior to age seven. Provide information supporting the diagnosis obtained from the student/parents/and teachers. Indicate the ADHD symptoms that were present during early school years \(e.g. daydreamer, spoke out of turn, unable to sit still, difficulty following directions, etc.\))/Type/Annot/V(The provider signing this form must be the same person answering the questions belowThe provider signing this form must be the same person answering the questions belowThe provider signing this form must be the same person answering the questions belowThe provider signing this form must be the same person answering the questions belowThe provider signing this form must be the same person answering the questions belowThe provider signing this form must be the same person answering the questions belowThe provider signing this form must be the same person answering the questions belowThe provider signing this form must be the same person answering the questions belowThe provider signing this form must be the same person answering the questions belowThe provider signing this form must be the same person answering the questions belowThe provider signing this form must be the same person answering the questions belowThe provider signing this form must be the same person answering the questions belowThe provider signing this form must be the same person answering the questions belowThe provider signing this form must be the same person answering the questions belowThe provider signing this form must be the same person answering the questions belowThe provider signing this form must be the same person answering the questions belowThe provider signing this form must be the same person answering the questions below)>> endobj 190 0 obj <>>>>>stream Hn\7 w.HM. dQux1Qbs xϧW7l߽9|86BhKkn>n?"֪gՖ|xx-ݱƼ?+1;ڝ-(w(J-8:e՛O秳ҭLG<} G%c1Iӣ.{RӷՕ0f3\\dDԠ$I JE7Dj@ej|q-\CzU2Nx:JfQiԼّYG72UTYn} -$"Z_ĩt޴ cTD:vC\ m OoW Dptt2pԝ I6 U\ @W0_J PEQW` c]TVO`Kp,3 x.K.,-Wg_1Hom%"av1<`SMg (J'!F{u={tf$$|TE-h2N}x˒G8Zfxwr 9'| nmMA[hA DKm"JWNi!S:ZP,T+q=MmbA2&k. 䑄^8*I]({R OS1pvA!KBG,[)/!&jЬNJK0,s`$o˚K ז D;t EMcJ<g(L&u823ָJI]oQC%:u{_孬`Lc`q,.*ȗ=\Zo.NҦzd%aא`[{ՌVPX9餳 T0c'QY4nν&uVu6o丷ETLa*©i\"Dj>'چخ!L@{ǚh {bq {5BZwOW 6*McL͕fF?od ʋ \vt]I}S $K⾌,H`V 9Up$\n: (5Z:ڕW ܰpb3j^903hvg ;d,tZEDu53x4%H:| Uc_XcZ| D8*Ju10z]NC}7ޜ~=+F0 endstream endobj 191 0 obj <>/DA(/Helv 10 Tf 0 g)/DR<>/Font<>>>/F 4/FT/Tx/Ff 4096/P 183 0 R/Rect[27.84 297.04 595.08 434.08]/StructParent 207/Subtype/Widget/T(3b Psychosocial History Provide relevant information obtained from the studentparentsguardians regarding the students psychosocial history eg often engaged in verbal or physical confrontation history of not sustaining relationships history of employment difficulties history of educational difficulties history of risktaking or dangerous activities history of impulsive behaviors social inappropriateness history of psychological treatment etc)/TU(3-b. Psychosocial History: Provide relevant information obtained from the student/parent\(s\)/guardian\(s\) regarding the students psychosocial history \(e.g. often engaged in verbal or physical confrontation, history of not sustaining relationships, history of employment difficulties, history of educational difficulties, history of risk-taking or dangerous activities, history of impulsive behaviors, social inappropriateness, history of psychological treatment, etc.\).)/Type/Annot/V(The provider signing this form must be the same person answering the questions belowThe provider signing this form must be the same person answering the questions belowThe provider signing this form must be the same person answering the questions belowThe provider signing this form must be the same person answering the questions belowThe provider signing this form must be the same person answering the questions belowThe provider signing this form must be the same person answering the questions belowThe provider signing this form must be the same person answering the questions belowThe provider signing this form must be the same person answering the questions belowThe provider signing this form must be the same person answering the questions belowThe provider signing this form must be the same person answering the questions belowThe provider signing this form must be the same person answering the questions belowThe provider signing this form must be the same person answering the questions belowThe provider signing this form must be the same person answering the questions belowThe provider signing this form must be the same person answering the questions belowThe provider signing this form must be the same person answering the questions belowThe provider signing this form must be the same person answering the questions belowThe provider signing this form must be the same person answering the questions below)>> endobj 192 0 obj <>>>>>stream HKo7 W̲]t&H(]E:NMQ`C~w>P,|/28Ț%r|Oo:=sm>\?>=ܳ29>ӗDZ9T.p?_?}}"eDD\݋r){| TT?5(IZ<IB$x + <$̤=D>ܔ"ڱ=#Ĵ7&<*| GtmnEȁ#0I)"G(<> Ucš?b$=;>ФD2& Je#EnDO! >jS" vRIkKE `1$4e!,C.cE2Zj_JV9u.1D":NdLuc$m) ܞ#tNf!qwHhDw\Tp( lx6R\>nGHJt⌈PȠ[2|M6& #LOh? +"DsF"$ƺBvYU\*E< [)o x'hv O2T!!҉'D(3i;i-f_zB ZyZtjN}x˒pXf U;9DWAJE9vV6AyZ{MDI]S@PCY׍Uzj|nդjƵНq4[|fG{7zr]Ũ@ O7UѡpvA[Gk,1&2h֒tI K0nwM`$o˚CY$3@50w~ڋ h/kl'ǹ˒x0,BvS/t853JkL5D[iD[SEͿi,Dy?KǼ ziX$QM6Y'[ClYQZ弇i^O8f#tmWN9BCqgd&Y6 ⇰:$5qL=Fr@K0Ok.P6d㲡KoESr2pF<fogqΚUANi(miz0Y*874D[q|EhiEE7J.xj]+ W͈ȸ8vʑM'mjGbfi@,]z.r6oxnߋSdөa©i\"Dqj>$چخL[h {jq {5B8_9+aנ¦4VlhMۂ.Ayy};Zn\{k1s k$2 AvZ I $$4¢I׮!l?.ƽN8cs֠i#^65FI>/DA(/Helv 10 Tf 0 g)/DR<>/Font<>>>/F 4/FT/Tx/Ff 4096/P 183 0 R/Rect[27.84 130.96 595.08 240.4]/StructParent 208/Subtype/Widget/T(3c Pharmacological History Provide relevant pharmacological history including an explanation of the extent to which the medication has mitigated the symptoms of the disorder in the past Also include any current medications that the students currently prescribed including dosage frequency of use the adverse side effects and the effectiveness of the medication)/TU(3-c. Pharmacological History: Provide relevant pharmacological history including an explanation of the extent to which the medication has mitigated the symptoms of the disorder in the past. Also include any current medication\(s\) that the students currently prescribed including dosage, frequency of use, the adverse side effects, and the effectiveness of the medication.)/Type/Annot/V(The provider signing this form must be the same person answering the questions belowThe provider signing this form must be the same person answering the questions belowThe provider signing this form must be the same person answering the questions belowThe provider signing this form must be the same person answering the questions belowThe provider signing this form must be the same person answering the questions belowThe provider signing this form must be the same person answering the questions belowThe provider signing this form must be the same person answering the questions belowThe provider signing this form must be the same person answering the questions belowThe provider signing this form must be the same person answering the questions belowThe provider signing this form must be the same person answering the questions belowThe provider signing this form must be the same person answering the questions belowThe provider signing this form must be the same person answering the questions belowThe provider signing this form must be the same person answering the questions belowThe provider signing this form must be the same person answering the questions belowThe provider signing this form must be the same person answering the questions below)>> endobj 194 0 obj <>>>>>stream H\7 y[&EdZNE2^/ݵwq?Ym$ûo7?-6/ljim;>~vAp^?OJ-RBʗg% !\埞.fǬRyv~:{®ܠjqT?>.9=0<0z U1I%r3Ԇ}}u%l,ˁp5(#I5D( ."L\Vp ӵWD0ni4GQ7!2y!#i_9~QQ/m$TBWHީڲ6,ѥ$n^TMX]kG+bs 0^5 ި}\:lK؉KTd9릇s/ci$Bh9^zT`*Yc0{۔nTz!/Bd%}Pp m(m ѳm""ڵI-{GHY<^g >VʉѯVC֙ @2x iH'n+3鼧ִ*~=+q# endstream endobj 195 0 obj <>/DA(/Helv 10 Tf 0 g)/DR<>/Font<>>>/F 4/FT/Tx/Ff 4096/P 183 0 R/Rect[27.84 33.88 595.08 101.92]/StructParent 209/Subtype/Widget/T(3d Educational History Provide a history of the use of any educational accommodations and services related to this disability)/TU(3-d. Educational History: Provide a history of the use of any educational accommodations and services related to this disability.)/Type/Annot/V(The provider signing this form must be the same person answering the questions belowThe provider signing this form must be the same person answering the questions belowThe provider signing this form must be the same person answering the questions belowThe provider signing this form must be the same person answering the questions belowThe provider signing this form must be the same person answering the questions belowThe provider signing this form must be the same person answering the questions belowThe provider signing this form must be the same person answering the questions belowThe provider signing this form must be the same person answering the questions belowThe provider signing this form must be the same person answering the questions belowThe provider signing this form must be the same person answering the questions belowThe provider signing this form must be the same person answering the questions belowThe provider signing this form must be the same person answering the questions below)>> endobj 196 0 obj <>>>>>stream Hn\7 w.HM. dQ`vE)8vq>~'vkQuqzx}g{oׇ7_vx6;.mǛ??]m?_\kW}սfj˽|=^+eK.&Ng% !\o.fǬRv~:{®ܠjqT?܌.|?ja":X=*WAP'oWݭvRHJiX0+jPh F5jQ\$D-ɵk2gҫL Jsq3!2;d3BmOx\cuεy*"Jc;G..R_Ac=GPL4Nfyd aRw8T 0N*.Tq0^fl(g0ǃCI^52|umLb@RY>/b讈`ɝiu &X"uAgi98WX1)e[sA[ExK3A}.. 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229.68]/Subtype/Widget/T(Educational History)/TU(Educational History)/Type/Annot/removed true>> endobj 1285 0 obj <>/Subtype/Form/Type/XObject>>stream /Tx BMC EMC endstream endobj 1286 0 obj <>/P 1281 0 R/S/Form>> endobj 1287 0 obj <> endobj 1288 0 obj <> endobj 1289 0 obj <> endobj 1290 0 obj <>/P 1287 0 R/S/Form>> endobj 1291 0 obj <>/P 1287 0 R/S/Form>> endobj 1292 0 obj <> endobj 1293 0 obj <> endobj 1294 0 obj <> endobj 1295 0 obj <>/P 1293 0 R/S/Form>> endobj 1296 0 obj <>/DA(/Helv 0 Tf 0 g)/DR<>/Font<>>>/F 4/FT/Tx/P 17 0 R/Rect[24.84 144.24 211.56 173.04]/Subtype/Widget/T(Behavioral Observations)/TU(Behavioral Observations)/Type/Annot/removed true>> endobj 1297 0 obj <>/Subtype/Form/Type/XObject>>stream /Tx BMC EMC endstream endobj 1298 0 obj <>/P 1293 0 R/S/Form>> endobj 1299 0 obj <> endobj 1300 0 obj <> endobj 1301 0 obj <>/P 1299 0 R/S/Form>> endobj 1302 0 obj <>/DA(/Helv 0 Tf 0 g)/DR<>/Font<>>>/F 4/FT/Tx/P 17 0 R/Rect[213.84 144.24 364.56 173.04]/Subtype/Widget/T(Medical History)/TU(Medical History)/Type/Annot/removed true>> endobj 1303 0 obj <>/Subtype/Form/Type/XObject>>stream /Tx BMC EMC endstream endobj 1304 0 obj <>/P 1299 0 R/S/Form>> endobj 1305 0 obj <> endobj 1306 0 obj <> endobj 1307 0 obj <>/P 1305 0 R/S/Form>> endobj 1308 0 obj <>/DA(/Helv 0 Tf 0 g)/DR<>/Font<>>>/F 4/FT/Tx/P 17 0 R/Rect[366.48 144.24 594.48 160.68]/Subtype/Widget/T(Standardized or NonStandardized Rating Scales)/TU(Standardized or Non-Standardized Rating Scales)/Type/Annot/removed true>> endobj 1309 0 obj <>/Subtype/Form/Type/XObject>>stream /Tx BMC EMC endstream endobj 1310 0 obj <>/P 1305 0 R/S/Form>> endobj 1311 0 obj <> endobj 1312 0 obj <> endobj 1313 0 obj <> endobj 1314 0 obj <>/P 1312 0 R/S/Form>> endobj 1315 0 obj <>/P 1312 0 R/S/Form>> endobj 1316 0 obj <> endobj 1317 0 obj <> endobj 1318 0 obj <> endobj 1319 0 obj <> endobj 1320 0 obj <><><>]/P 1317 0 R/S/Form>> endobj 1321 0 obj <> endobj 1322 0 obj <> endobj 1323 0 obj <> endobj 1324 0 obj <> endobj 1325 0 obj <> endobj 1326 0 obj <> endobj 1327 0 obj <> endobj 1328 0 obj <> endobj 1329 0 obj <> endobj 1330 0 obj <> endobj 1331 0 obj <> endobj 1332 0 obj <> endobj 1333 0 obj <> endobj 1334 0 obj <> endobj 1335 0 obj <> endobj 1336 0 obj <> endobj 1337 0 obj <> endobj 1338 0 obj <> endobj 1339 0 obj <> endobj 1340 0 obj <> endobj 1341 0 obj <> endobj 1342 0 obj <> endobj 1343 0 obj <> endobj 1344 0 obj <> endobj 1345 0 obj <> endobj 1346 0 obj <> endobj 1347 0 obj <>/P 1346 0 R/S/Form>> endobj 1348 0 obj <> endobj 1349 0 obj <> endobj 1350 0 obj <> endobj 1351 0 obj <> endobj 1352 0 obj <> endobj 1353 0 obj <> endobj 1354 0 obj <>/P 1353 0 R/S/Form>> endobj 1355 0 obj <> endobj 1356 0 obj <> endobj 1357 0 obj <>/P 1356 0 R/S/Form>> endobj 1358 0 obj <> endobj 1359 0 obj <> endobj 1360 0 obj <>/P 1359 0 R/S/Form>> endobj 1361 0 obj <> endobj 1362 0 obj <> endobj 1363 0 obj <>/P 1362 0 R/S/Form>> endobj 1364 0 obj <> endobj 1365 0 obj <> endobj 1366 0 obj <> endobj 1367 0 obj <>/P 1365 0 R/S/Form>> endobj 1368 0 obj <> endobj 1369 0 obj <> endobj 1370 0 obj <> endobj 1371 0 obj <> endobj 1372 0 obj <> endobj 1373 0 obj <> endobj 1374 0 obj <> endobj 1375 0 obj <> endobj 1376 0 obj <> endobj 1377 0 obj <> endobj 1378 0 obj <> endobj 1379 0 obj <> endobj 1380 0 obj <> endobj 1381 0 obj <> endobj 1382 0 obj <> endobj 1383 0 obj <> endobj 1384 0 obj <><><><><><><><><>]/P 1373 0 R/S/Form>> endobj 1385 0 obj <> endobj 1386 0 obj <> endobj 1387 0 obj <> endobj 1388 0 obj <> endobj 1389 0 obj <> endobj 1390 0 obj <> endobj 1391 0 obj <> endobj 1392 0 obj <> endobj 1393 0 obj <> endobj 1394 0 obj <> endobj 1395 0 obj <> endobj 1396 0 obj <> endobj 1397 0 obj <><><><><><><><><>]/P 1386 0 R/S/Form>> endobj 1398 0 obj <> endobj 1399 0 obj <> endobj 1400 0 obj <> endobj 1401 0 obj <> endobj 1402 0 obj <> endobj 1403 0 obj <> endobj 1404 0 obj <> endobj 1405 0 obj <> endobj 1406 0 obj <> endobj 1407 0 obj <> endobj 1408 0 obj <> endobj 1409 0 obj <> endobj 1410 0 obj <> endobj 1411 0 obj <>/P 1409 0 R/S/Form>> endobj 1412 0 obj <>/DA(/Helv 0 Tf 0 g)/DR<>/Font<>>>/F 4/FT/Tx/P 208 0 R/Q 1/Rect[307.32 232.8 374.16 246.96]/Subtype/Widget/T(NegligibleConcentrating)/TU(Negligible_Concentrating)/Type/Annot/removed true>> endobj 1413 0 obj <>/Subtype/Form/Type/XObject>>stream /Tx BMC EMC endstream endobj 1414 0 obj <> endobj 1415 0 obj <> endobj 1416 0 obj <>/P 1414 0 R/S/Form>> endobj 1417 0 obj <>/DA(/Helv 0 Tf 0 g)/DR<>/Font<>>>/F 4/FT/Tx/P 208 0 R/Q 1/Rect[375.48 232.8 440.28 246.96]/Subtype/Widget/T(ModerateConcentrating)/TU(Moderate_Concentrating)/Type/Annot/removed true>> endobj 1418 0 obj <>/Subtype/Form/Type/XObject>>stream /Tx BMC EMC endstream endobj 1419 0 obj <> endobj 1420 0 obj <> endobj 1421 0 obj <>/P 1419 0 R/S/Form>> endobj 1422 0 obj <>/DA(/Helv 0 Tf 0 g)/DR<>/Font<>>>/F 4/FT/Tx/P 208 0 R/Q 1/Rect[441.6 232.8 518.16 246.96]/Subtype/Widget/T(SubstantialConcentrating)/TU(Substantial_Concentrating)/Type/Annot/removed true>> endobj 1423 0 obj <>/Subtype/Form/Type/XObject>>stream /Tx BMC EMC endstream endobj 1424 0 obj <> endobj 1425 0 obj <> endobj 1426 0 obj <>/P 1424 0 R/S/Form>> endobj 1427 0 obj <>/DA(/Helv 0 Tf 0 g)/DR<>/Font<>>>/F 4/FT/Tx/P 208 0 R/Q 1/Rect[519.48 232.8 599.04 246.96]/Subtype/Widget/T(Dont KnowConcentrating)/TU(Dont Know_Concentrating)/Type/Annot/removed true>> endobj 1428 0 obj <>/Subtype/Form/Type/XObject>>stream /Tx BMC EMC endstream endobj 1429 0 obj <> endobj 1430 0 obj <> endobj 1431 0 obj <> endobj 1432 0 obj <> endobj 1433 0 obj <>/P 1431 0 R/S/Form>> endobj 1434 0 obj <>/DA(/Helv 0 Tf 0 g)/DR<>/Font<>>>/F 4/FT/Tx/P 208 0 R/Q 1/Rect[307.32 218.4 374.16 231.72]/Subtype/Widget/T(NegligibleMemory)/TU(Negligible_Memory)/Type/Annot/removed true>> endobj 1435 0 obj <>/Subtype/Form/Type/XObject>>stream /Tx BMC EMC endstream endobj 1436 0 obj <> endobj 1437 0 obj <> endobj 1438 0 obj <>/P 1436 0 R/S/Form>> endobj 1439 0 obj <>/DA(/Helv 0 Tf 0 g)/DR<>/Font<>>>/F 4/FT/Tx/P 208 0 R/Q 1/Rect[375.48 218.4 440.28 231.72]/Subtype/Widget/T(ModerateMemory)/TU(Moderate_Memory)/Type/Annot/removed true>> endobj 1440 0 obj <>/Subtype/Form/Type/XObject>>stream /Tx BMC EMC endstream endobj 1441 0 obj <> endobj 1442 0 obj <> endobj 1443 0 obj <>/P 1441 0 R/S/Form>> endobj 1444 0 obj <>/DA(/Helv 0 Tf 0 g)/DR<>/Font<>>>/F 4/FT/Tx/P 208 0 R/Q 1/Rect[441.6 218.4 518.16 231.72]/Subtype/Widget/T(SubstantialMemory)/TU(Substantial_Memory)/Type/Annot/removed true>> endobj 1445 0 obj <>/Subtype/Form/Type/XObject>>stream /Tx BMC EMC endstream endobj 1446 0 obj <> endobj 1447 0 obj <> endobj 1448 0 obj <>/P 1446 0 R/S/Form>> endobj 1449 0 obj <>/DA(/Helv 0 Tf 0 g)/DR<>/Font<>>>/F 4/FT/Tx/P 208 0 R/Q 1/Rect[519.48 218.4 599.04 231.72]/Subtype/Widget/T(Dont KnowMemory)/TU(Dont Know_Memory)/Type/Annot/removed true>> endobj 1450 0 obj <>/Subtype/Form/Type/XObject>>stream /Tx BMC EMC endstream endobj 1451 0 obj <> endobj 1452 0 obj <> endobj 1453 0 obj <> endobj 1454 0 obj <> endobj 1455 0 obj <>/P 1453 0 R/S/Form>> endobj 1456 0 obj <>/DA(/Helv 0 Tf 0 g)/DR<>/Font<>>>/F 4/FT/Tx/P 208 0 R/Q 1/Rect[307.32 204.12 374.16 217.32]/Subtype/Widget/T(NegligibleSocial interactions)/TU(Negligible_Social interactions)/Type/Annot/removed true>> endobj 1457 0 obj <>/Subtype/Form/Type/XObject>>stream /Tx BMC EMC endstream endobj 1458 0 obj <> endobj 1459 0 obj <> endobj 1460 0 obj <>/P 1458 0 R/S/Form>> endobj 1461 0 obj <>/DA(/Helv 0 Tf 0 g)/DR<>/Font<>>>/F 4/FT/Tx/P 208 0 R/Q 1/Rect[375.48 204.12 440.28 217.32]/Subtype/Widget/T(ModerateSocial interactions)/TU(Moderate_Social interactions)/Type/Annot/removed true>> endobj 1462 0 obj <>/Subtype/Form/Type/XObject>>stream /Tx BMC EMC endstream endobj 1463 0 obj <> endobj 1464 0 obj <> endobj 1465 0 obj <>/P 1463 0 R/S/Form>> endobj 1466 0 obj <>/DA(/Helv 0 Tf 0 g)/DR<>/Font<>>>/F 4/FT/Tx/P 208 0 R/Q 1/Rect[441.6 204.12 518.16 217.32]/Subtype/Widget/T(SubstantialSocial interactions)/TU(Substantial_Social interactions)/Type/Annot/removed true>> endobj 1467 0 obj <>/Subtype/Form/Type/XObject>>stream /Tx BMC EMC endstream endobj 1468 0 obj <> endobj 1469 0 obj <> endobj 1470 0 obj <>/P 1468 0 R/S/Form>> endobj 1471 0 obj <>/DA(/Helv 0 Tf 0 g)/DR<>/Font<>>>/F 4/FT/Tx/P 208 0 R/Q 1/Rect[519.48 204.12 599.04 217.32]/Subtype/Widget/T(Dont KnowSocial interactions)/TU(Dont Know_Social interactions)/Type/Annot/removed true>> endobj 1472 0 obj <>/Subtype/Form/Type/XObject>>stream /Tx BMC EMC endstream endobj 1473 0 obj <> endobj 1474 0 obj <> endobj 1475 0 obj <> endobj 1476 0 obj <> endobj 1477 0 obj <>/P 1475 0 R/S/Form>> endobj 1478 0 obj <>/DA(/Helv 0 Tf 0 g)/DR<>/Font<>>>/F 4/FT/Tx/P 208 0 R/Q 1/Rect[307.32 189.84 374.16 203.04]/Subtype/Widget/T(NegligibleNote taking)/TU(Negligible_Note taking)/Type/Annot/removed true>> endobj 1479 0 obj <>/Subtype/Form/Type/XObject>>stream /Tx BMC EMC endstream endobj 1480 0 obj <> endobj 1481 0 obj <> endobj 1482 0 obj <>/P 1480 0 R/S/Form>> endobj 1483 0 obj <>/DA(/Helv 0 Tf 0 g)/DR<>/Font<>>>/F 4/FT/Tx/P 208 0 R/Q 1/Rect[375.48 189.84 440.28 203.04]/Subtype/Widget/T(ModerateNote taking)/TU(Moderate_Note taking)/Type/Annot/removed true>> endobj 1484 0 obj <>/Subtype/Form/Type/XObject>>stream /Tx BMC EMC endstream endobj 1485 0 obj <> endobj 1486 0 obj <> endobj 1487 0 obj <>/P 1485 0 R/S/Form>> endobj 1488 0 obj <>/DA(/Helv 0 Tf 0 g)/DR<>/Font<>>>/F 4/FT/Tx/P 208 0 R/Q 1/Rect[441.6 189.84 518.16 203.04]/Subtype/Widget/T(SubstantialNote taking)/TU(Substantial_Note taking)/Type/Annot/removed true>> endobj 1489 0 obj <>/Subtype/Form/Type/XObject>>stream /Tx BMC EMC endstream endobj 1490 0 obj <> endobj 1491 0 obj <> endobj 1492 0 obj <>/P 1490 0 R/S/Form>> endobj 1493 0 obj <>/DA(/Helv 0 Tf 0 g)/DR<>/Font<>>>/F 4/FT/Tx/P 208 0 R/Q 1/Rect[519.48 189.84 599.04 203.04]/Subtype/Widget/T(Dont KnowNote taking)/TU(Dont Know_Note taking)/Type/Annot/removed true>> endobj 1494 0 obj <>/Subtype/Form/Type/XObject>>stream /Tx BMC EMC endstream endobj 1495 0 obj <> endobj 1496 0 obj <> endobj 1497 0 obj <> endobj 1498 0 obj <> endobj 1499 0 obj <>/P 1497 0 R/S/Form>> endobj 1500 0 obj <>/DA(/Helv 0 Tf 0 g)/DR<>/Font<>>>/F 4/FT/Tx/P 208 0 R/Q 1/Rect[307.32 175.56 374.16 188.76]/Subtype/Widget/T(NegligibleRegular class attendance)/TU(Negligible_Regular class attendance)/Type/Annot/removed true>> endobj 1501 0 obj <>/Subtype/Form/Type/XObject>>stream /Tx BMC EMC endstream endobj 1502 0 obj <> endobj 1503 0 obj <> endobj 1504 0 obj <>/P 1502 0 R/S/Form>> endobj 1505 0 obj <>/DA(/Helv 0 Tf 0 g)/DR<>/Font<>>>/F 4/FT/Tx/P 208 0 R/Q 1/Rect[375.48 175.56 440.28 188.76]/Subtype/Widget/T(ModerateRegular class attendance)/TU(Moderate_Regular class attendance)/Type/Annot/removed true>> endobj 1506 0 obj <>/Subtype/Form/Type/XObject>>stream /Tx BMC EMC endstream endobj 1507 0 obj <> endobj 1508 0 obj <> endobj 1509 0 obj <>/P 1507 0 R/S/Form>> endobj 1510 0 obj <>/DA(/Helv 0 Tf 0 g)/DR<>/Font<>>>/F 4/FT/Tx/P 208 0 R/Q 1/Rect[441.6 175.56 518.16 188.76]/Subtype/Widget/T(SubstantialRegular class attendance)/TU(Substantial_Regular class attendance)/Type/Annot/removed true>> endobj 1511 0 obj <>/Subtype/Form/Type/XObject>>stream /Tx BMC EMC endstream endobj 1512 0 obj <> endobj 1513 0 obj <> endobj 1514 0 obj <>/P 1512 0 R/S/Form>> endobj 1515 0 obj <>/DA(/Helv 0 Tf 0 g)/DR<>/Font<>>>/F 4/FT/Tx/P 208 0 R/Q 1/Rect[519.48 175.56 599.04 188.76]/Subtype/Widget/T(Dont KnowRegular class attendance)/TU(Dont Know_Regular class attendance)/Type/Annot/removed true>> endobj 1516 0 obj <>/Subtype/Form/Type/XObject>>stream /Tx BMC EMC endstream endobj 1517 0 obj <> endobj 1518 0 obj <> endobj 1519 0 obj <> endobj 1520 0 obj <> endobj 1521 0 obj <>/P 1519 0 R/S/Form>> endobj 1522 0 obj <>/DA(/Helv 0 Tf 0 g)/DR<>/Font<>>>/F 4/FT/Tx/P 208 0 R/Q 1/Rect[307.32 161.28 374.16 174.48]/Subtype/Widget/T(NegligibleLearning)/TU(Negligible_Learning)/Type/Annot/removed true>> endobj 1523 0 obj <>/Subtype/Form/Type/XObject>>stream /Tx BMC EMC endstream endobj 1524 0 obj <> endobj 1525 0 obj <> endobj 1526 0 obj <>/P 1524 0 R/S/Form>> endobj 1527 0 obj <>/DA(/Helv 0 Tf 0 g)/DR<>/Font<>>>/F 4/FT/Tx/P 208 0 R/Q 1/Rect[375.48 161.28 440.28 174.48]/Subtype/Widget/T(ModerateLearning)/TU(Moderate_Learning)/Type/Annot/removed true>> endobj 1528 0 obj <>/Subtype/Form/Type/XObject>>stream /Tx BMC EMC endstream endobj 1529 0 obj <> endobj 1530 0 obj <> endobj 1531 0 obj <>/P 1529 0 R/S/Form>> endobj 1532 0 obj <>/DA(/Helv 0 Tf 0 g)/DR<>/Font<>>>/F 4/FT/Tx/P 208 0 R/Q 1/Rect[441.6 161.28 518.16 174.48]/Subtype/Widget/T(SubstantialLearning)/TU(Substantial_Learning)/Type/Annot/removed true>> endobj 1533 0 obj <>/Subtype/Form/Type/XObject>>stream /Tx BMC EMC endstream endobj 1534 0 obj <> endobj 1535 0 obj <> endobj 1536 0 obj <>/P 1534 0 R/S/Form>> endobj 1537 0 obj <>/DA(/Helv 0 Tf 0 g)/DR<>/Font<>>>/F 4/FT/Tx/P 208 0 R/Q 1/Rect[519.48 161.28 599.04 174.48]/Subtype/Widget/T(Dont KnowLearning)/TU(Dont Know_Learning)/Type/Annot/removed true>> endobj 1538 0 obj <>/Subtype/Form/Type/XObject>>stream /Tx BMC EMC endstream endobj 1539 0 obj <> endobj 1540 0 obj <> endobj 1541 0 obj <> endobj 1542 0 obj <> endobj 1543 0 obj <>/P 1541 0 R/S/Form>> endobj 1544 0 obj <>/DA(/Helv 0 Tf 0 g)/DR<>/Font<>>>/F 4/FT/Tx/P 208 0 R/Q 1/Rect[307.32 147 374.16 160.2]/Subtype/Widget/T(NegligibleReading)/TU(Negligible_Reading)/Type/Annot/removed true>> endobj 1545 0 obj <>/Subtype/Form/Type/XObject>>stream /Tx BMC EMC endstream endobj 1546 0 obj <> endobj 1547 0 obj <> endobj 1548 0 obj <>/P 1546 0 R/S/Form>> endobj 1549 0 obj <>/DA(/Helv 0 Tf 0 g)/DR<>/Font<>>>/F 4/FT/Tx/P 208 0 R/Q 1/Rect[375.48 147 440.28 160.2]/Subtype/Widget/T(ModerateReading)/TU(Moderate_Reading)/Type/Annot/removed true>> endobj 1550 0 obj <>/Subtype/Form/Type/XObject>>stream /Tx BMC EMC endstream endobj 1551 0 obj <> endobj 1552 0 obj <> endobj 1553 0 obj <>/P 1551 0 R/S/Form>> endobj 1554 0 obj <>/DA(/Helv 0 Tf 0 g)/DR<>/Font<>>>/F 4/FT/Tx/P 208 0 R/Q 1/Rect[441.6 147 518.16 160.2]/Subtype/Widget/T(SubstantialReading)/TU(Substantial_Reading)/Type/Annot/removed true>> endobj 1555 0 obj <>/Subtype/Form/Type/XObject>>stream /Tx BMC EMC endstream endobj 1556 0 obj <> endobj 1557 0 obj <> endobj 1558 0 obj <>/P 1556 0 R/S/Form>> endobj 1559 0 obj <>/DA(/Helv 0 Tf 0 g)/DR<>/Font<>>>/F 4/FT/Tx/P 208 0 R/Q 1/Rect[519.48 147 599.04 160.2]/Subtype/Widget/T(Dont KnowReading)/TU(Dont Know_Reading)/Type/Annot/removed true>> endobj 1560 0 obj <>/Subtype/Form/Type/XObject>>stream /Tx BMC EMC endstream endobj 1561 0 obj <> endobj 1562 0 obj <> endobj 1563 0 obj <> endobj 1564 0 obj <> endobj 1565 0 obj <>/P 1563 0 R/S/Form>> endobj 1566 0 obj <>/DA(/Helv 0 Tf 0 g)/DR<>/Font<>>>/F 4/FT/Tx/P 208 0 R/Q 1/Rect[307.32 132.6 374.16 145.92]/Subtype/Widget/T(NegligibleThinking)/TU(Negligible_Thinking)/Type/Annot/removed true>> endobj 1567 0 obj <>/Subtype/Form/Type/XObject>>stream /Tx BMC EMC endstream endobj 1568 0 obj <> endobj 1569 0 obj <> endobj 1570 0 obj <>/P 1568 0 R/S/Form>> endobj 1571 0 obj <>/DA(/Helv 0 Tf 0 g)/DR<>/Font<>>>/F 4/FT/Tx/P 208 0 R/Q 1/Rect[375.48 132.6 440.28 145.92]/Subtype/Widget/T(ModerateThinking)/TU(Moderate_Thinking)/Type/Annot/removed true>> endobj 1572 0 obj <>/Subtype/Form/Type/XObject>>stream /Tx BMC EMC endstream endobj 1573 0 obj <> endobj 1574 0 obj <> endobj 1575 0 obj <>/P 1573 0 R/S/Form>> endobj 1576 0 obj <>/DA(/Helv 0 Tf 0 g)/DR<>/Font<>>>/F 4/FT/Tx/P 208 0 R/Q 1/Rect[441.6 132.6 518.16 145.92]/Subtype/Widget/T(SubstantialThinking)/TU(Substantial_Thinking)/Type/Annot/removed true>> endobj 1577 0 obj <>/Subtype/Form/Type/XObject>>stream /Tx BMC EMC endstream endobj 1578 0 obj <> endobj 1579 0 obj <> endobj 1580 0 obj <>/P 1578 0 R/S/Form>> endobj 1581 0 obj <>/DA(/Helv 0 Tf 0 g)/DR<>/Font<>>>/F 4/FT/Tx/P 208 0 R/Q 1/Rect[519.48 132.6 599.04 145.92]/Subtype/Widget/T(Dont KnowThinking)/TU(Dont Know_Thinking)/Type/Annot/removed true>> endobj 1582 0 obj <>/Subtype/Form/Type/XObject>>stream /Tx BMC EMC endstream endobj 1583 0 obj <> endobj 1584 0 obj <> endobj 1585 0 obj <> endobj 1586 0 obj <> endobj 1587 0 obj <>/P 1585 0 R/S/Form>> endobj 1588 0 obj <>/DA(/Helv 0 Tf 0 g)/DR<>/Font<>>>/F 4/FT/Tx/P 208 0 R/Q 1/Rect[307.32 118.32 374.16 131.52]/Subtype/Widget/T(NegligibleCommunicating)/TU(Negligible_Communicating)/Type/Annot/removed true>> endobj 1589 0 obj <>/Subtype/Form/Type/XObject>>stream /Tx BMC EMC endstream endobj 1590 0 obj <> endobj 1591 0 obj <> endobj 1592 0 obj <>/P 1590 0 R/S/Form>> endobj 1593 0 obj <>/DA(/Helv 0 Tf 0 g)/DR<>/Font<>>>/F 4/FT/Tx/P 208 0 R/Q 1/Rect[375.48 118.32 440.28 131.52]/Subtype/Widget/T(ModerateCommunicating)/TU(Moderate_Communicating)/Type/Annot/removed true>> endobj 1594 0 obj <>/Subtype/Form/Type/XObject>>stream /Tx BMC EMC endstream endobj 1595 0 obj <> endobj 1596 0 obj <> endobj 1597 0 obj <>/P 1595 0 R/S/Form>> endobj 1598 0 obj <>/DA(/Helv 0 Tf 0 g)/DR<>/Font<>>>/F 4/FT/Tx/P 208 0 R/Q 1/Rect[441.6 118.32 518.16 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Indicate the ADHD symptoms that were\ present during early school years \(e.g. daydreamer, spoke out of turn, unable to sit still, difficulty following directions, etc.\))/Type/Annot>> endobj 191 0 obj <>/DA(/Helv 10 Tf 0 g)/DR<>/Font<>>>/F 4/FT/Tx/Ff 4096/P 183 0 R/Rect[27.84 297.04 595.08 434.08]/StructParent 207/Subtype/Widget/T(3b Psychosocial History Provide relevant information obtained from the studentparentsguardians regarding the students psychosocial history eg often engaged in verbal or physical confrontation history of not sustaining relationships history of employment d\ ifficulties history of educational difficulties history of risktaking or dangerous activities history of impulsive behaviors social inappropriateness history of psychological treatment etc)/TU(3-b. Psychosocial History: Provide relevant information obtained from the student/parent\(s\)/guardian\(s\) regarding the students psychosocial history \(e.g. often engaged in verbal or physical confrontation, history of not sustaining relationships, his\ tory of employment difficulties, history of educational difficulties, history of risk-taking or dangerous activities, history of impulsive behaviors, social inappropriateness, history of psychological treatment, etc.\).)/Type/Annot>> endobj 193 0 obj <>/DA(/Helv 10 Tf 0 g)/DR<>/Font<>>>/F 4/FT/Tx/Ff 4096/P 183 0 R/Rect[27.84 130.96 595.08 240.4]/StructParent 208/Subtype/Widget/T(3c Pharmacological History Provide relevant pharmacological history including an explanation of the extent to which the medication has mitigated the symptoms of the disorder in the past Also include any current medications that the students currently pres\ cribed including dosage frequency of use the adverse side effects and the effectiveness of the medication)/TU(3-c. Pharmacological History: Provide relevant pharmacological history including an explanation of the extent to which the medication has mitigated the symptoms of the disorder in the past. Also include any current medication\(s\) that the students curre\ ntly prescribed including dosage, frequency of use, the adverse side effects, and the effectiveness of the medication.)/Type/Annot>> endobj 195 0 obj <>/DA(/Helv 10 Tf 0 g)/DR<>/Font<>>>/F 4/FT/Tx/Ff 4096/P 183 0 R/Rect[27.84 33.88 595.08 101.92]/StructParent 209/Subtype/Widget/T(3d Educational History Provide a history of the use of any educational accommodations and services related to this disability)/TU(3-d. Educational History: Provide a history of the use of any educational accommodations and services related to this disability.)/Type/Annot>> endobj 210 0 obj <>/DA(/Helv 10 Tf 0 g)/DR<>/Font<>>>/F 4/FT/Tx/P 208 0 R/Rect[386.04 756.84 593.88 775.604]/StructParent 204/Subtype/Widget/T(Students Name_3)/TU(Students Name)/Type/Annot>> endobj 214 0 obj <>/N<>>>/AS/Off/DA(/ZaDb 6 Tf 0 g)/F 4/FT/Btn/MK<>/P 208 0 R/Rect[47.8227 691.999 56.5391 700.822]/StructParent 321/Subtype/Widget/T(Often fails to give close attention to details or makes careless mistakes in schoolwork work or other)/TU(Often fails to give close attention to details or makes careless mistakes in schoolwork, work or other activities.)/Type/Annot>> endobj 218 0 obj <>/N<>>>/AS/Off/DA(/ZaDb 6 Tf 0 g)/F 4/FT/Btn/MK<>/P 208 0 R/Rect[47.7409 664.481 56.4982 673.14]/StructParent 322/Subtype/Widget/T(Often has difficulty sustaining attention in tasks or play activities)/TU(Often has difficulty sustaining attention in tasks or play activities.)/Type/Annot>> endobj 222 0 obj <>/N<>>>/AS/Off/DA(/ZaDb 6 Tf 0 g)/F 4/FT/Btn/MK<>/P 208 0 R/Rect[47.7409 650.64 56.58 659.299]/StructParent 323/Subtype/Widget/T(Often does not seem to listen when spoken to directly)/TU(Often does not seem to listen when spoken to directly.)/Type/Annot>> endobj 226 0 obj <>/N<>>>/AS/Off/DA(/ZaDb 6 Tf 0 g)/F 4/FT/Btn/MK<>/P 208 0 R/Rect[47.7818 636.799 56.4982 645.499]/StructParent 324/Subtype/Widget/T(Often does not follow through on instructions and details to finish schoolwork chores or duties in)/TU(Often does not follow through on instructions and details to finish schoolwork, chores, or duties in the workplace \(not due to oppositional behavior or failure to understand instructions\).)/Type/Annot>> endobj 230 0 obj <>/N<>>>/AS/Off/DA(/ZaDb 6 Tf 0 g)/F 4/FT/Btn/MK<>/P 208 0 R/Rect[47.7818 609.319 56.4982 618.019]/StructParent 325/Subtype/Widget/T(Often has difficulty organizing tasks and activities)/TU(Often has difficulty organizing tasks and activities.)/Type/Annot>> endobj 234 0 obj <>/N<>>>/AS/Off/DA(/ZaDb 6 Tf 0 g)/F 4/FT/Btn/MK<>/P 208 0 R/Rect[47.7409 595.478 56.4573 604.26]/StructParent 326/Subtype/Widget/T(Often avoids dislikes or is reluctant to engage in tasks such as schoolwork or homework that)/TU(Often avoids, dislikes, or is reluctant to engage in tasks \(such as schoolwork or homework\) that require sustained mental effort.)/Type/Annot>> endobj 238 0 obj <>/N<>>>/AS/Off/DA(/ZaDb 6 Tf 0 g)/F 4/FT/Btn/MK<>/P 208 0 R/Rect[47.8227 568.001 56.5391 576.66]/StructParent 327/Subtype/Widget/T(Often loses things necessary for tasks or activities eg school assignments pencils books tools)/TU(Often loses things necessary for tasks or activities \(e.g. school assignments, pencils, books, tools, etc.\))/Type/Annot>> endobj 242 0 obj <>/N<>>>/AS/Off/DA(/ZaDb 6 Tf 0 g)/F 4/FT/Btn/MK<>/P 208 0 R/Rect[47.7818 540.36 56.5391 549.101]/StructParent 328/Subtype/Widget/T(Is often easily distracted by extraneous 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or in other situations that require remaining in place\).)/Type/Annot>> endobj 258 0 obj <>/N<>>>/AS/Off/DA(/ZaDb 6 Tf 0 g)/F 4/FT/Btn/MK<>/P 208 0 R/Rect[47.7818 456.905 56.5255 465.633]/StructParent 331/Subtype/Widget/T(Often runs about or climbs in situations where it is inappropriate May be limited to feeling restless)/TU(Often runs about or climbs in situations where it is inappropriate. \(May be limited to feeling restless\).)/Type/Annot>> endobj 262 0 obj <>/N<>>>/AS/Off/DA(/ZaDb 6 Tf 0 g)/F 4/FT/Btn/MK<>/P 208 0 R/Rect[47.7818 443.16 56.4709 451.833]/StructParent 332/Subtype/Widget/T(Often unable to play or engage in leisure activities quietly)/TU(Often unable to play or engage in leisure activities quietly.)/Type/Annot>> endobj 266 0 obj <>/N<>>>/AS/Off/DA(/ZaDb 6 Tf 0 g)/F 4/FT/Btn/MK<>/P 208 0 R/Rect[47.7818 429.415 56.4436 438.005]/StructParent 333/Subtype/Widget/T(Is often on the go acting as if driven by a motor eg is unable to be or uncomfortable being still f)/TU(Is often on the go, acting as if driven by a motor \(e.g., is unable to be or uncomfortable being still fextended time, may be experienced by others as being restless or difficult to keep up with\).)/Type/Annot>> endobj 270 0 obj <>/N<>>>/AS/Off/DA(/ZaDb 6 Tf 0 g)/F 4/FT/Btn/MK<>/P 208 0 R/Rect[47.7818 401.76 56.5255 410.433]/StructParent 334/Subtype/Widget/T(Often talks excessively)/TU(Often talks excessively.)/Type/Annot>> endobj 274 0 obj <>/N<>>>/AS/Off/DA(/ZaDb 6 Tf 0 g)/F 4/FT/Btn/MK<>/P 208 0 R/Rect[47.7545 388.08 56.5255 396.78]/StructParent 335/Subtype/Widget/T(Often blurts out an answer before a question has been completed eg completes peoples sentence)/TU(Often blurts out an answer before a question has been completed \(e.g., completes peoples sentence cannot wait for turn in conversation\).)/Type/Annot>> endobj 278 0 obj <>/N<>>>/AS/Off/DA(/ZaDb 6 Tf 0 g)/F 4/FT/Btn/MK<>/P 208 0 R/Rect[47.8091 360.48 56.5255 369.153]/StructParent 336/Subtype/Widget/T(Often has difficulty 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