SELPA Referral Procedures
The parent/guardian should initial each applicable statement listed under the Parental Authorization section of form DM 66.
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.
2.
Referral Procedures
Forward the following documents to the attention of the OT/PT Supervisor at the SELPA.
DM 120B – Physical Therapy Referral
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• DM 63 – Authorization for Use and/or Disclosure of Information
DM 66 – Assessment Plan
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• 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
3.
Timeline for Assessment
Within five business days of receipt of the completed referral packet, the OT/PT Supervisor 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 form the date the Assessment Plan was received by the LEA.
4.
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 OT/PT Supervisor at the SELPA with a request to schedule an IEP meeting.
The director of special education will reconvene the IEP team to determine whether 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.
CAHELP JPA Referral Procedures
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Revised 8/9/2022
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