Sample FAACT letter:

http://www.foodallergyawareness.org/media/civilrights/4-%20Sample%20Doctor%20Letter%20for%20504_FINAL%20with%20Logo.pdf

Quote from: sbs on April 22, 2012, 03:57:00 PM

Quote from: CMdeux on April 22, 2012, 02:21:36 PM
criteria for disability under Section 504 of the Rehabilitation Act of 1973 (ADA and ADAA of 2008).

ok, I'm reading this "A Complex Recipe: Food Allergies and the Law"  http://www.wisbar.org/am/template.cfm?section=wisconsin_lawyer&template=/cm/contentdisplay.cfm&contentid=92733 and they  are referring to ADAAA instead of ADAA - is there a reason I'm seeing it both ways?

In elig letters, would it make more sense to say
"criteria for disability under Section 504 of the Rehabilitation Act of 1973 and (ADA)/(ADAAA of 2008)" since the Rehab act seems independent of the ADA's?

I would just pick one or the other.  I'm not sure that there is enough case law to know which is eventually going to be the preferred acronym. 

If this applies I'd want it to say that if your child touches allergen residue and then touches eyes, nose or mouth your child can have anaphylaxis so it is very important that your child's classroom and lessons/activities be allergen-free.

Quote from: CMdeux on April 22, 2012, 02:21:36 PM
criteria for disability under Section 504 of the Rehabilitation Act of 1973 (ADA and ADAA of 2008).

ok, I'm reading this "A Complex Recipe: Food Allergies and the Law"  http://www.wisbar.org/am/template.cfm?section=wisconsin_lawyer&template=/cm/contentdisplay.cfm&contentid=92733 and they  are referring to ADAAA instead of ADAA - is there a reason I'm seeing it both ways?

In elig letters, would it make more sense to say
"criteria for disability under Section 504 of the Rehabilitation Act of 1973 and (ADA)/(ADAAA of 2008)" since the Rehab act seems independent of the ADA's?

CM -   

You are going through so much and you still make time to help.

I hope that I can return the favor someday. 

Absolutely.

That is why we share all this stuff here!!

You might also look at Seeking official accommodations via the College Board (SAT/PSAT/AP) for the updated letter, written to address the needs of an adolescent who is some six years older than the child in the letter above.

(off to add link)

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Quote from: CMdeux on April 03, 2012, 11:46:20 PM
Okay, this is really just sort of ancillary-- we have a 504 review planned and the counselor (who is brand new on the job, and I don't think has much experience with FA or other chronic medical conditions as a basis for being a QID) decided that the allergist's letter was "dated."

Well, fine.  We needed to get something current for the College Board anyway. (They prefer documentation which is within the same year as the first planned exam).

So we are getting an updated magic letter from Dr. Awesome for our 504 team and the school, too--  (Please note that this is the ADOLESCENT version of this document, which is admittedly a complete and total, no-wiggle-room-allowed, no-holds-barred, SLEDGEHAMMER of a document in support of 504 eligibility.)  My profound and eternal thanks to GailW and her DD for letting me see and tweak their original into this eventual form.     I'll forever be paying that debt forward.  Truly.    

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(DATE)

To Whom It May Concern:

  I have been asked by {CM DD}'s parents to provide medical information regarding {DD}'s allergies.  I understand that you need specific and current information that will be used to determine whether or not {DD} meets the criteria for disability under Section 504 of the Rehabilitation Act of 1973 (ADA and ADAA of 2008).  I believe that {DD} qualifies for this designation based upon her diagnosis and clinical history of life-threatening (anaphylactic) food allergy.

Anaphylaxis is defined as a systemic allergic reaction which may cause death or permanent disability.  At least 150 people die each year in the United States due to anaphylactic reactions to foods, most commonly to peanuts.  Below, I briefly describe the body systems affected during anaphylaxis:

Systems and Symptoms:

Skin and subcutaneous tissues: flushing, mouth itching and swelling of the lips, tongue, or mouth, and/or hives.

Gastrointestinal system: nausea, abdominal cramps, vomiting and diarrhea (if severe, can cause intravascular volume depletion and shock).

Respiratory system: sense of tightness/itching in the throat, hoarseness due to edema of the larynx (may close the airway), hacking cough, shortness of breath, and/or wheezing.

Cardiovascular system: "thready" pulse, decreased cardiac function, decrease in blood pressure which may lead to dizziness, loss of consciousness, shock, and possible cardiac arrest.

  {DD} has required emergent medical care for anaphylaxis on more than one occasion.  She has a history of rapidly progressing anaphylaxis involving the skin, gastrointestinal, respiratory, and cardiovascular systems.  Due to this reaction history and her asthma, {DD} is at elevated risk for fatal anaphylaxis.

{DD} was diagnosed with life-threatening food allergies at 11 months, following emergency medical care for peanut-induced anaphylaxis.  Since that time, she has also been diagnosed with life-threatening asthma and allergies to eggs and several tree nuts (almond, pistachio, cashew, etc.).  She has a clinical history of reactivity to ingestion of microscopic quantities of allergens, contact with allergens, and inhalation of allergens.  Some reactions have been atypically-presenting (without airway or skin features) and therefore very challenging to correctly identify in a timely fashion.  Possible anaphylaxis symptoms must be treated as a medical emergency.

For the purposes of a Section 504 designation, I attest that {DD}'s medical condition substantially and significantly affects the life functions of caring for herself, normal immune function, and eating.  Anaphylaxis can, when active, also substantially and significantly limit the life functions of breathing, talking, walking, normal cardiovascular function, thinking and performing manual tasks, among others.

There is no cure for food anaphylaxis.  Unlike other allergies for which treatment options include medications or immunotherapy (allergy shots), presently all such treatments for food allergy are considered investigational and high-risk.  There is no such approved treatment or device that can act as a mitigating measure for those who are anaphylactic to foods.  Regular maintenance medications do not eliminate the need to practice avoidance, nor does epinephrine or any other rescue medication or device necessarily resolve anaphylaxis or eliminate the need to seek additional emergent care.  Death or permanent disability is a possible outcome any time anaphylaxis is triggered.  Peanut is of particular concern since triggering doses may be very small and too variable to be reliably determined for an individual.  Therefore, total avoidance of allergenic foods is imperative.

Avoidance of all contact with food allergens (peanut, egg, and tree nuts) is the only way to avoid a potentially life-threatening allergic reaction.  Such avoidance is a highly complex task requiring excellent judgment and social skills, particularly when needs place a person in conflict with a peer group.  This is difficult for adolescents, whose executive skills are not yet mature and who may take unacceptably large risks or even hide/dismiss emergent symptoms in order to gain social acceptance with peers.   Adolescents must be strongly encouraged to advocate assertively for their needs as appropriate and guided toward good management decisions as they assume the responsibility for their food allergies.

Successful avoidance requires a comprehensive written accommodation plan in consultation with the patient, parents, and physician.    I consider {DD}'s parents; CM DH, Ph.D., and CM Ph.D., to be knowledgeable about the successful management of their daughter's medical condition.

Sincerely,

Awesome Person, M.D.
{additional fancy qualifications as he sees fit}

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Obviously, there are significant elements there which include my daughter's specific allergens and her specific history.  It's probably also true that mentioning one's own qualifications is probably not necessary, but if you have a terminal degree, (particularly an MD or PhD) it probably doesn't hurt to put it out there since you're basically having the physician say that you are "EXPERTS" yourselves.     I've found that it can garner some street cred when it's sorely needed (as in negotiations with school staff over something that they don't feel like doing).

(I've added 'asthma' which was an editorial change made by our allergist when he delivered the finished document on letterhead.)

Other things that differentiate the two letters--

the PATIENT is included as a part of the team in this one (as an adolescent should be),
SOCIAL ramifications and the peculiar pressures of adolescence in this dimension have been addressed,
ADAA was not yet law when the first letter was composed (pre-2008).

HTH!

Quote

To Whom It May Concern:
I have been asked by XX XX's parents to provide medical information regarding XX�s allergies. I understand that you need specific and current information that will be used to determine whether or not XX meets the criteria for a 504 Designation under Section 504 of the Rehabilitation Act of 1973. I believe XX qualifies for this designation based upon his diagnosis and clinical history of life-threatening (anaphylactic) food allergies.
Anaphylaxis is defined as a systemic allergy reaction and can cause death or permanent disability. Approximately 150 people die each year due to anaphylaxis to foods, most commonly to peanuts. Below, I briefly describe the body systems affected during anaphylaxis:

Systems & Symptoms

Skin and subcutaneous tissues: mouth itching and swelling of the lips, tongue, or mouth, and hives.
Gastrointestinal system: nausea, abdominal cramps, vomiting and/or diarrhea (the vomiting and diarrhea can be severe, leading to intravascular volume depletion and shock).
Respiratory system: throat itching and/or sense of tightness in the throat, hoarseness sue to edema in the larynx with the possibility of closure of the airway, hacking cough, shortness of breath, repetitive coughing, and/or wheezing.
Cardiovascular system: "thready" pulse, decreased cardiac function leading to drop in blood pressure and shock, leading to possible cardiac arrest.

XX has a history of rapidly progressing anaphylaxis involving the gastrointestinal, skin, respiratory, and cardiovascular systems. Due to this reaction history, XX is at elevated risk of a fatal anaphylaxis.
XX was diagnosed with life-threatening food allergies at the age of 1 1/2 years. Since that time, he has also been diagnosed with severe, potentially life-threatening allergies to all tree nuts and eggs. (Test results available upon request). XX has a clinical history of reactivity to ingestion of microscopic quantities of allergens, contact with allergens, and inhalation of allergens.
For the purposes of this letter for a Section 504 designation, I attest that XX�s medical condition substantially and significantly affects the life function of caring for one�s self, and may also substantially and significantly limit the life functions of breathing, talking, walking, and performing manual tasks.

There is no cure for food anaphylaxis. Unlike other allergies for which there are medications or immunotherapy, there is no medication, immunotherapy, or device which can act as a mitigating measure for those who are anaphylactic to foods. Regular maintenance medications do not eliminate the need to practice avoidance, nor does epinephrine or any other rescue medication or device necessarily resolve anaphylaxis or eliminate the need to seek additional emergent care. Death or permanent disability is a possible outcome any time anaphylaxis is triggered. Peanut is of particular concern since a triggering dose cannot be reliably determined, even for an individual. Total avoidance is imperative.
Avoidance of all contact with food allergens (peanut, egg, and all tree nuts) is the only way to avoid a potentially life-threatening allergic reaction. Such avoidance is a highly complex task, impossible for a child without the ongoing assistance of an adult who is knowledgeable about the condition. Successful avoidance requires a comprehensive written accommodation plan in consultation with parents and physician.
I consider XX�s parents, XX and XX XX, to be knowledgeable about the successful management of their son�s medical condition.
Sincerely,
Dr. XXX, M.D.

Is it ok if I also use much of the wording from this letter?  I will have to change some stuff. 

 Posted: 02.11.2010 at 03:43:20     

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I have heard nothing from the coordinator since my request. They know that we're seeing the allergist soon and I think they are waiting to get the signed blanket waivers (I won't sign) back. I'm planning to ask our allergist to write a letter on his letterhead indicating the accommodations dd needs, but I'm not going to give it to the school until AFTER we're approved for the 504. Right? So, what should letter #2 say in terms of qualifying her? LTFA, and what else? I have no current rast scores, and one very recent documented ER visit. 

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Posted: 02.11.2010 at 03:51:13       

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It should (ideally) say that your child QUALIFIES under section 504, and clearly state which major life activities are 'substantially limited' by the disability.


at a minimum, it MUST state that there is a history of life-threatening allergy to the allergen, and that there are no "mitigating" measures for that. The epipen is not a "mitigating" measure, because it doesn't lessen the burden imposed by the underlying allergy.


There is a wonderful example of an eligibility letter in the resources section here (look up top near the forum heading under 'schools' and you'll see it).

That one is very carefully crafted to reflect the precise verbiage used in the law.

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Posted: 02.11.2010 at 03:53:44       

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01.24.2008 at 03:15:35, notnutty wrote:

Tips from Momcat regarding doctor letter (thanks Momcat!)

QuoteThe first step to getting adequate accommodations for you son is to get a good letter from the allergist. It should include

1. A diagnosis of peanut allergy with the risk of life-threatening reactions. The life-threatening part is crucial.

2. Description of symptoms and emergency treatment protocol (Epipen, Benadryl Rx)

3. Description of preventative measures required, e.g. peanut/nut-free classroom, eating area.

4. Description in the right legal terminology showing that your son is substantially limited in his ability to breathe, eat, and care for himself (i.e. manage his own allergies).

Once you have the letter, you need to formally (in writing) request an evaluation for 504 eligibility for your son.

If he is found eligible for a 504 Plan, then you will meet with the school to discuss accommodations (i.e. the specific contents of the plan.)

I'll continue adding some other helpful tips/links to get you started. 

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Posted: 02.11.2010 at 04:05:51       

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Does anyone have a link to the letter template?


I can post it, but if a link already exists, that would be best.

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Posted: 02.11.2010 at 07:00:35       

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We had no issues with getting D qualified for a 504 Plan, which doesn't mean that someone couldn't submit the exact same letter elsewhere and be denied.

Our allergist's letter stated that:
(1) DD has MLTFA, which had been established by reaction history, RAST scores, and skin testing. I would NOT recite dates or RAST scores. I think the fact RAST testing has confirmed the allergy should suffice, without opening the door for the school questioning the validity of the dr.'s conclusion

(2) DD has a history of anaphylactic reactions.

(3) DD has asthma.

(4) Both the history of anaphylaxis and asthma increase her risk that any reaction will be fatal (life-threatening).

(5) DD has a history of reaction to very minute amounts of the allergen, including traces of allergens from the manufacturing process.

(6) Complete avoidance of the allergen is necessary.

(7) The impact on breathing.

I have a slightly different view here. I am not sure that a doctor can authoritatively state that a child qualifies for a 504 Plan. That is a legal conclusion. It's like "informed consent" forms. The question of whether consent is "informed," is a legal conclusion to be made by a judge or trier of fact.

I would focus on documenting each aspect of 504's requirements: disability, substantially affects, major life activity, "life-threatening." 

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Posted: 02.11.2010 at 10:54:35       

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Thank you, that helps a lot. If anyone has the link to the template mentioned, I would really appreciate it.

Met our new allergist today. He's going to be a great ally. 

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To Whom It May Concern:
I have been asked by XX XX's parents to provide medical information regarding XX�s allergies. I understand that you need specific and current information that will be used to determine whether or not XX meets the criteria for a 504 Designation under Section 504 of the Rehabilitation Act of 1973. I believe XX qualifies for this designation based upon his diagnosis and clinical history of life-threatening (anaphylactic) food allergies.
Anaphylaxis is defined as a systemic allergy reaction and can cause death or permanent disability. Approximately 150 people die each year due to anaphylaxis to foods, most commonly to peanuts. Below, I briefly describe the body systems affected during anaphylaxis:

Systems & Symptoms

Skin and subcutaneous tissues: mouth itching and swelling of the lips, tongue, or mouth, and hives.
Gastrointestinal system: nausea, abdominal cramps, vomiting and/or diarrhea (the vomiting and diarrhea can be severe, leading to intravascular volume depletion and shock).
Respiratory system: throat itching and/or sense of tightness in the throat, hoarseness sue to edema in the larynx with the possibility of closure of the airway, hacking cough, shortness of breath, repetitive coughing, and/or wheezing.
Cardiovascular system: "thready" pulse, decreased cardiac function leading to drop in blood pressure and shock, leading to possible cardiac arrest.

XX has a history of rapidly progressing anaphylaxis involving the gastrointestinal, skin, respiratory, and cardiovascular systems. Due to this reaction history, XX is at elevated risk of a fatal anaphylaxis.
XX was diagnosed with life-threatening food allergies at the age of 1 1/2 years. Since that time, he has also been diagnosed with severe, potentially life-threatening allergies to all tree nuts and eggs. (Test results available upon request). XX has a clinical history of reactivity to ingestion of microscopic quantities of allergens, contact with allergens, and inhalation of allergens.
For the purposes of this letter for a Section 504 designation, I attest that XX�s medical condition substantially and significantly affects the life function of caring for one�s self, and may also substantially and significantly limit the life functions of breathing, talking, walking, and performing manual tasks.

There is no cure for food anaphylaxis. Unlike other allergies for which there are medications or immunotherapy, there is no medication, immunotherapy, or device which can act as a mitigating measure for those who are anaphylactic to foods. Regular maintenance medications do not eliminate the need to practice avoidance, nor does epinephrine or any other rescue medication or device necessarily resolve anaphylaxis or eliminate the need to seek additional emergent care. Death or permanent disability is a possible outcome any time anaphylaxis is triggered. Peanut is of particular concern since a triggering dose cannot be reliably determined, even for an individual. Total avoidance is imperative.
Avoidance of all contact with food allergens (peanut, egg, and all tree nuts) is the only way to avoid a potentially life-threatening allergic reaction. Such avoidance is a highly complex task, impossible for a child without the ongoing assistance of an adult who is knowledgeable about the condition. Successful avoidance requires a comprehensive written accommodation plan in consultation with parents and physician.
I consider XX�s parents, XX and XX XX, to be knowledgeable about the successful management of their son�s medical condition.
Sincerely,
Dr. XXX, M.D.

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Posted: 02.12.2010 at 10:55:12       

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Rebekah and I are going to have to figure out what happened to our up-loaded content on the web-server that Boo was using originally; when I try to access the template letter that we had there, I can't get in to see any of the content. This is obviously a problem.

This may take some time, however-- which is in short supply over the next few days.



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The letter posted above is basically identical to the one that we used-- based on Gail's original, we tweaked it to include additional affected life activities (self-care being HUGE) and to emphasize that an epinephrine injection is not a PLAN for management.

Our allergist was perfectly happy to sign it-- he even wanted an electronic copy of it. (He had considerable experience with section 504 already as he had in the past acted as a school "expert" on FA management and 504 evaluation/implementation... many physicians may balk at some of the legal language. Educate your physician FIRST by supplying them with position statements from AAAAI and AAFA, both of which specifically address asthma and allergies from a section 504 standpoint.  )

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Posted: 02.12.2010 at 11:21:44       

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That letter is excellent. A little tweaking here and there for our particular case and I feel confident we'd be in very good shape. Our new allergist didn't know a lot about 504's, but supported us in whatever we wanted to do. I suggested that I could draft the letter and he said he would sign it. He was very impressed with my knowledge and how I've managed her allergy to milk so well for 7 yrs. He said he trusted in me as the "expert." LOL.