Desert Mountain Charter SELPA Policies and Procedures

Procedure – Category 5000 (Students) AR 5005.4 – SELPA Referral Procedures

3. Complete the Physical Therapy Referral form (DM 120B) and obtain the signatures of the person making the referral and the director of special education. B. Referral Procedures Forward the following documents to the attention of the Program Manager for Resolution Support Services at the SELPA. • DM 52 – Transfer into LEA • DM 63 – Authorization for Use and/or Disclosure of Information • DM 120B – Physical Therapy Referral • Current physical therapy report, if available, that specifies the physical therapy services the student was receiving and the physical therapy goals. • IEP or IEP Addendum dated within one year of the transfer referral for physical therapy that lists physical therapy services and goals. • Psych-educational evaluation dated within three years of the transfer referral for physical therapy. C. Timeline for Assessment An assessment is not required for transfer referrals. Assessments are completed at three-year intervals (from the date that the services originally began) unless there are extenuating circumstances that dictate otherwise. D. Timeline for Services PT services for the student will begin immediately upon receipt of the physical therapy transfer referral packet by the SELPA physical therapist. The SELPA will enter the PT services into the IEP system.

12.0 Residential Placement (RTC)

12.1 Initial Referral

A. Pre-referral

LEA Responsibility:

AR 5005.4 – SELPA Referral Procedures Desert Mountain Charter Special Education Local Plan Area (DMCS) (rev. 8/9/22)

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