Appendix F: Referral to the Desert Mountain Children’s Center for Evaluation
IEE for Occupational Therapy (OT), Psychoeducational, and Speech and Language Evaluation
4. Complete the Authorization for Use and/or Disclosure of Information form (DM 63) and obtain the parent/guardian signature. Specify the receiving agency as the Desert Mountain Children’s Center.
Referral Procedures Checklist:
Forward the following documents to the attention of the Director of the DMCC.
➢ DMCC 100F Referral for Independent Educational Evaluation form
➢ DM 63 Authorization for Use and/or Disclosure of Information form
➢ Occupational Therapy, Psycho-educational, or Speech and Language prior evaluation report, if available and as applicable to the IEE request, that specifies services the student was receiving and the goals related to the services
➢ IEP or IEP Addendum dated within one year of the referral for an IEE to the DMCC to assess in the identified area of need
➢ Psycho-educational evaluation dated within three years of the referral for an IEE to the DMCC
➢ Any additional supporting information
Timeline for Assessment
Within five business days of receipt of the completed referral packet, the Director of the DMCC shall:
1. Assign and forward the Referral for Independent Educational Evaluation form (DMCC 100F) to a credentialed, certified and/or licensed DMCC evaluator.
2. Forward a copy of the Referral for Independent Educational Evaluation form (DMCC 100F) to the appropriate support person to document in client file and route to the DMCC Business Office.
The assigned DMCC evaluator shall:
1. Contact the parent/guardian and LEA to coordinate assessment needs. Parent/guardian is responsible for making the child available for the assessment (including transportation).
2. Release a copy of his/her written evaluation report to the LEA prior to the IEP team meeting. Report must include examiner’s name, title, license, certification number; original
BP 2009 – Guidelines for Independent Educational Evaluation (IEE) Desert Mountain Special Education Local Plan Area (DMSELPA) (rev. 11/21)
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