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Notes from _______________________ IEP

Key personnel  TVI: 

O&M: 

Other: 

Information relating to  Visual acuity
visual condition Right eye: _______  Left eye: ________
        

Visual fields
 Right eye: _______  Left eye: ________

Impact of visual impairment on learning:

Other health/medication 
information

Reading and writing  Reading: 
medium

Writing: 

Assistive 
technology/devices

Accommodations  
Instructional materials

Annual review date

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