NDAEB Medical Accommodation Request Form

Page 3 of 4 When was the candidate diagnosed with this condition? I diagnosed the candidate’s disability or am confirming their pregnancy/maternity-related needs: OR I did NOT diagnose the candidate’s disability. I confirm the diagnosis. The NDAEB Written exam is a computer-based multiple-choice exam, delivered over 4 hours at a Testing Center. Based on your knowledge of the candidate’s functional limitations, please indicate the accommodation(s) requested. The types of accommodation which the NDAEB may be able to provide if required, are set out below, however, this is not a comprehensive list of all accommodations which may be possible. Briefly explain how the candidate’s functional limitations will impact their ability to complete the NDAEB Written Exam under standard testing conditions. Please indicate below, in your professional capacity/opinion, why the candidate needs this accommodation. Please explain each that you selected. Extra time (time and one half = 6 hours) Separate room Text-to-speech software* (e.g. Kurzweil) Recorder** (in-person) Medical device (please specify - e.g. insulin pump, glucose monitor, insulin pen etc.) Other (please specify – e.g. emergency snacks, scrap paper, pencil, stress ball, noise cancelling headphones etc.) Do you have any additional comments that are relevant to the accommodation request? *Text-to-speech software is site specific and cannot be guaranteed. **If a Recorder is provided as a result of the request for special accommodation, the Recorder, the NDAEB and its agents “assume no liability” and “are not responsible” for ensuring the accuracy of the Written Examination and/or Clinical Practice Evaluation (CPE) results, and it is the candidate’s responsibility to ensure that the answers are recorded according to their instructions.

RkJQdWJsaXNoZXIy MzA1NjE=