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. Referral Procedures Forward the following documents to the attention of the Program Manager for Resolution Support Services at the SELPA. • D/M 120B Physical Therapy Referral form • D/M 63 Authorization for Use and/or Disclosure of Information form • D/M 66 Assessment Plan form • IEP or IEP Addendum dated within one year of the referral for physical therapy • Psycho-educational evaluation dated within three years of the referral for physical therapy 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 review the packet for completion and forward it to the appropriate physical 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 PT assessment, a report will be sent to the director of special education by the physical therapist 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 PT services are warranted. If the IEP team agrees that services are not needed, it will be documented in the IEP notes. If the IEP team agrees that services are appropriate, the service should be listed on an Addendum to the IEP including the projected start date, duration, and frequency. The Addendum should be forwarded to the Program Manager for Resolution Support Services at the SELPA. Within five (5) business days of receipt of the Addendum to the IEP, the Program Manager for Resolution Support Services at the SELPA will assign a physical therapist and determine initiation of services. The SELPA will enter the PT services into the SELPA Management Information System (MIS) database.
Chapter 22 – Supports and Services, Charter SELPA As of 10/17/2019 D/M Charter SELPA Steering Committee Approval
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