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format of certificate for income tax benefit FORM NO. 10-IA[See sub-rule (2) of rule 11A] Certificate of the medical authority for certifying ‘person with disability’, ‘severe disability’, ‘autism’, ‘cerebral palsy’ and ‘multiple disability’ for purposes of section 80DD and section 80U
Certificate No. Date: 1. This is to certify that Shri .......................................... son/daughter of Shri ............................., age years male/female residing at Mumbai, Registration No: xxxxxxx is a person with AUTISM as per DSM V criteria with disability/severe disability* suffering from autism, with intellectual disability and speech delay and hyperactivity.and needs substantial support for this year. 2. This condition is non-progressive/likely to improve partially. 3. Reassessment is recommended after a period of 1 year for certifying disability and every 3 monthly for deciding goals. He/She had shown substantial improvement in understanding and communication over last 2 months of Goal directed cognitive approach. Genetic / syndromic / metabolic association of the symptom complex is not evaluated. He/she is physically fit to join normal school /a special school or institution for supportive services,. He /she needs specific set of daily medicines, occupational therapy, spech therapy, ABA therapy for two years which may need titration on monthly basis. IQ test shouldnot be a prerequisite for school admission.
Sd/- (Neurologist/Pediatric Neurologist/Civil Surgeon/Chief Medical Officer*)
Name: Dr. Santosh Kondekar MD DNB DCH FCPS FAIMER DDN CDC KERALA, FELLOWSHIP PEDIATRIC NEUROLOGY AND EPILEPSSY MUHS /TNMCAddress of Institution/Government hospital: Qualification/designation of specialist:rn 86230/mmc
Certificate No. Date: 1. This is to certify that Shri .......................................... son/daughter of Shri ............................., age years male/female residing at Mumbai, Registration No: xxxxxxx is a person with AUTISM as per DSM V criteria with disability/severe disability* suffering from autism, with intellectual disability and speech delay and hyperactivity.and needs substantial support for this year. 2. This condition is non-progressive/likely to improve partially. 3. Reassessment is recommended after a period of 1 year for certifying disability and every 3 monthly for deciding goals. He/She had shown substantial improvement in understanding and communication over last 2 months of Goal directed cognitive approach. Genetic / syndromic / metabolic association of the symptom complex is not evaluated. He/she is physically fit to join normal school /a special school or institution for supportive services,. He /she needs specific set of daily medicines, occupational therapy, spech therapy, ABA therapy for two years which may need titration on monthly basis. IQ test shouldnot be a prerequisite for school admission.
Sd/- (Neurologist/Pediatric Neurologist/Civil Surgeon/Chief Medical Officer*)
Name: Dr. Santosh Kondekar MD DNB DCH FCPS FAIMER DDN CDC KERALA, FELLOWSHIP PEDIATRIC NEUROLOGY AND EPILEPSSY MUHS /TNMCAddress of Institution/Government hospital: Qualification/designation of specialist:rn 86230/mmc
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