The Application - Page 4

MEDICAL REPORT:

This one obviously needs to be done by the applicant's doctor. It includes all the applicants personal info (name, address, OHIP #, phone #, D.O.B., etc.)

The doctor fills in:

• a current diagnosis
• date of onset
• diagnosis disussed with (patient, family)
• brief health history
• present condition
• medications
• allergies
• and if needed, a psychological/behavioural report.