a. The person making the referral should check the box that corresponds to the type of assessment(s) requested. b. The parent/guardian should initial each applicable statement listed under the Parental Authorization section of form D/M 66. c. It is important that the parent/guardian return the form to the LEA on the date that it is signed or as soon as possible thereafter. When the signed Assessment Plan is received by the LEA, it should be date stamped. 4. Complete the Authorization for Use and/or Disclosure of Information form (D/M 63) and obtain the parent/guardian signature. Specify the receiving agency’s name if known. If not, leave the field blank. Referral Procedures Forward the following completed documents to the attention of the Program Manager for Resolution Support Services at the SELPA. • D/M 120A Occupational Therapy Referral form • D/M 66 Assessment Plan form • D/M 63 Authorization for Use and/or Disclosure of Information form • IEP or IEP Addendum dated within one year of the referral for occupational therapy • Psycho-educational evaluation dated within three years of the referral for occupational therapy • Any additional supporting information Timeline for Assessment Within five business days of receipt of the completed referral packet, the Program Manager for Resolution Support Services at the SELPA, will forward it to a SELPA occupational therapist. The assessment must occur within 60 calendar days from the date the Assessment Plan was received by the LEA. Timeline for Services Upon completion of the OT assessment, a report will be sent to the Director of Special Education by either the occupational therapist that conducted the assessment or the Program Manager for Resolution Support Services at the SELPA with a request to schedule an IEP meeting. The director of special education will reconvene the IEP team to determine whether or not services are warranted.
Chapter 22 – Supports and Services, Charter SELPA As of 10/17/2019 D/M Charter SELPA Steering Committee Approval
Page 94
Made with FlippingBook - professional solution for displaying marketing and sales documents online