Note Taking Form

Notes from _______________________ IEP

Key personnel

TVI:

O&M:

Other:

Information relating to visual condition

Visual acuity
Right eye: ___________
Left eye: ___________

Visual fields
Right eye: ___________
Left eye: ___________

Impact of visual impairment on learning:

Other health/medication information  
Reading and writing medium

Reading:

Writing:

Assistive technology/devices  
Accommodations  
Instructional materials  
Annual review date  
Print Friendly, PDF & Email