Medical Student Health Assessment (Page 5 of 8) in pdf

Medical Student Health Assessment Page 5

Section 2: Providing reasonable adjustments

In order to help us plan to make reasonable adjustments please supply the following

information.

1. Do any of the following present you with difficulty?:

Mobility e.g. walking, using stairs

Yes

Agility e.g. bending, reaching up, kneeling down, maintaining balance

Yes

Dexterity e.g. writing, using tools

Yes

Physical exertion e.g. lifting, carrying

Yes

Communication e.g. speech

Yes

Hearing e.g. deaf, hard of hearing, tinnitus

Yes

Vision e.g. blind, visual impairment, colour blindness, tunnel vision

Yes

Learning e.g. dyslexia, dyspraxia, dyscalculia, impaired concentration

Yes

If yes to any of the above, give details e.g. extent of impairment, any support needs or

course adjustments required.

2. Have you ever required arrangements at school, college or work to overcome barriers,

e.g. equipment, extra time in exams, part-time working?

Ye s

If yes, give details:

3. Do you have any of the following:

Chronic skin conditions? e.g. eczema, psoriasis

Yes

Neurological disorder? e.g. epilepsy, multiple sclerosis

Yes

Allergies? e.g. to latex, medicines, foods

Yes

Endocrine disease? e.g. diabetes

Yes

If yes to any of the above, give details (e.g. when condition developed, severity, treatment

and course adjustments required).

Medical Student Health Assessment Page 5