Health Conditions, Mobility, Hearing, Speech, or
Visual Impairment

                                                                                                                                                                      
A letter or report from treating physician, orthopedic specialist, audiologist, speech pathologist, or ophthalmologist (as appropriate), including:

* Clearly stated diagnosis
* Defined levels of functioning and any limitations
* Current treatment and medication
* Current letter/report (within 1year), dated and signed