Collection of PHYSICIAN LETTERs used to obtain a 504 Designation: Post yours please!

Posted on: Mon, 03/06/2006 - 2:24am
Gail W's picture
Joined: 12/06/2001 - 09:00

There are several very good allergist/pediatrician letters posted under Schools. Some have their own threads and others are buried within threads. I thought it may be helpful to collect them in one location so that they are more easily accessible and so that we can look at them for comparison... and learn. Please feel free to post or cut/paste your letter here.


Posted on: Mon, 03/06/2006 - 2:48am
Gail W's picture
Joined: 12/06/2001 - 09:00

From here: [url=""][/url]
Dr. xxxx
Director of Instructional Resources
xxx School District
May 9, 2005
To Whom It May Concern:
I have been asked by Mariah X's parents to provide medical information regarding Mariah

Posted on: Mon, 03/06/2006 - 2:52am
Gail W's picture
Joined: 12/06/2001 - 09:00

Rhonda RS's letter from here: [url=""][/url]
(Current Date)
(Mother's Name)
(Father's Name)
Patient: (Child's Name): (Date of Birth)
(Home Street Address)
(Town, State, Zip Code)
Telephone: (telephone number)
E-Mail: (parent's e-mail address)
Dear Dr. (Doctor's Last Name),
(We wrote a personal note thanking him/her for working with us and our child and all the help sh/e has given us thus far.)
We are getting ready to send (the child's first name) to (preschool or public school), and want to have (him/her) in place an accommodation plan that addresses his/her safety needs. To achieve this goal, we need a letter from you stating the circumstances surrounding (Child's Name) allergies. This letter will entitle us to important educational meetings. I am asking for a lot of specific information so that the school can really understand the nature of (Child's Name) allergies and the seriousness of (Child's name) peanut allergy. Could you please discuss the following topics? We greatly appreciate your assistance.
1. Could you please address the letter to (Formal Name of the School District) Administrators, School Nurses and Teachers.
2. (Child's) full name and date of birth.
3. Date of allergy testing.
4. List of allergies confirmed.
5. Other medical conditions: ex. Asthma.
6. Type of reaction your (Child) has to allergy, contact, inhalation, ingestion of the allergen.
*7. *Life Systems that are affected by (the child's) allergic reaction: These life systems include: Cardiovascular, digestive, respiratory and skin. *This topic is extremely important. It is especially important to state that anaphylaxis affects the "life system of breathing is affected."
8. Medical Treatment for allergic reactions.
List medicines that must be present with (Child) at all times.
9. List all medicines that (Child) is currently taking.
10. List medical devices that must be present with (Child) at all times (ex. Nebulizer & Albuterol or inhaler).
11. List other devices or medical aids that (Child) needs (ex. hepafilter, creams, etc.).
12. State that my husband and I are knowledgeable individuals who understand our child's condition and his/her safety needs.
Could you please mail the letter to us directly? We will make copies and keep it on file at our home.
In closing, thank you so much for all your help Dr. (Name of the Doctor). We appreciate your support. The documentation that you provide will help us tremendously in attaining our goal of providing (Name of the Child) with a safe and rich public school experience.
(Name of both of the Parent)

Posted on: Mon, 03/06/2006 - 3:00am
qdebbie1's picture
Joined: 02/10/2005 - 09:00

School District:
I have been asked by XX

Posted on: Mon, 03/06/2006 - 3:03am
qdebbie1's picture
Joined: 02/10/2005 - 09:00

Dear School District
X (DOB) is a patient with X Asthma and Allergy Center. It has been brought to my attention that the district is planning to continue serving peanut products in the cafeteria. I was unaware of cafeteria procedures when I signed off on the plan agreeing to eliminate peanut products only from the main menu.
*****this is when the school sent a proposed plan to my doctor and had him sign it and then said see dr x likes it...nice try******
As stated in my previous letter, X requires a safe learning environment in all classrooms, cafeteria and all shared facilities. Strict avoidance of the allergen is the only way to allow him to fully participate in all school activities. In order to reasonably accommodate this student

Posted on: Mon, 03/06/2006 - 3:04am
Gail W's picture
Joined: 12/06/2001 - 09:00

Corvallis Mom's letter from here: [url=""][/url]
To Whom It May Concern:
I have been asked by XXXXX XXXXX's parents to provide medical information regarding XXXXXX

Posted on: Mon, 03/06/2006 - 3:11am
qdebbie1's picture
Joined: 02/10/2005 - 09:00

Dear School District:
X X () is a patient with the X Asthma and Allergy Center under my direct care. He has been diagnosed with a life threatening peanut allergy. His test results are the highest level making his allergy extremely severe. X also has a history of anaphylactic reactions. This impairment will produce similar or worse reactions in the future. Any exposure to peanut products by ingestion, touch, or smell can cause a reaction that would quickly endanger his major life activity of breathing, possibly resulting in death.
X requires a safe learning environment in all classrooms, cafeteria, and all shared facilities. Strict avoidance of the allergen is the only way to allow him to fully participate in all school activities.
All teachers and staff involved with his education should be made aware of this condition and properly trained to handle emergency situations.
Please contact the office if you need further information.
X Asthma and Allergy Center
x0x-3xx 23x5

Posted on: Mon, 03/06/2006 - 3:14am
qdebbie1's picture
Joined: 02/10/2005 - 09:00

what a great idea.
you may notice I took some wording from other letters to create my own.
Sorry they are out of order, I thought it was such a good idea I jumped right in.
The last post is the first letter sent to the school. Then the next letter and the pediatrician letter. I also had a letter from his original allergist in ohio but it was more of a form letter version and not as helpful. And a letter from his Nurse practioner but the district said her opinion was invalid. That definately worked in my favor because she didnt like that comment, she lives in the district and was happy to have the pediatrician write anything help.
In total I had 2 letterst from his current allergist
1 from the allergist who did the testing
1 from a np( not on file)
1 from pediatrician.
My consent form only gave permission to talk with the allergist and they never called that I know of, only that tricky tactic at the beginning.
anyone is free to use all/any part of my letters.

Posted on: Mon, 03/06/2006 - 7:05am
Gail W's picture
Joined: 12/06/2001 - 09:00

Quote:Originally posted by qdebbie1:
[b]what a great idea.
you may notice I took some wording from other letters to create my own. Sorry they are out of order, I thought it was such a good idea I jumped right in.[/b]
Perfect. [img][/img] I hope more will jump right in too.
I think it's great to pull the best parts from all of the letters. Corvallis Mom used my letter as a base, but had her doctor add that she and her husband were "knowledgeable individuals". I thought that was a very excellent addition.

Posted on: Mon, 03/06/2006 - 7:11am
ajas_folks's picture
Joined: 04/28/2000 - 09:00

Gail, this "Clearing House" approach to these types of info is so very useful! Thanks for getting this going on the Schools Topic section.

Posted on: Mon, 03/06/2006 - 7:33am
Corvallis Mom's picture
Joined: 05/22/2001 - 09:00

Yes... My feeling is that the two strongest statements in our letter are the mention that anaphylaxis has an [i]uncertain outcome, no matter what you do at that point[/i] because that emphasizes avoidance, and also that [i]avoidance requires a well-educated adult(s) and cannot be a reasonable expectation of a child. [/i] Voila! We have simultaneously pointed our WHY a 504 plan is needed (inability to care for one's self) and that accommodations will need to include adult supervision!
... and we included information about previous reactions [i]because that was useful in our case[/i].... I also shamelessly plugged our terminal degrees in that "knowledgeable" statement, too! [img][/img] Heh heh heh.
(How many "doctors" does it take to establish a 504, anyway??) [img][/img]


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