SELPA Referral Procedures
Within five business days of receipt of the Addendum to the IEP, the OT/PT Supervisor at the SELPA will assign a physical therapist and determine initiation of services. The SELPA will enter the PT services into the IEP system.
B.
Transfer Referral
1.
Pre-referral
Local Educational Agency (LEA) Responsibility
a) Complete the Transfer into District form (DM 52) and obtain the parent/guardian signature.
b) 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 SELPA. c) Complete the Physical Therapy Referral form (DM 120B) and obtain the signatures of the person making the referral and the director of special education.
2.
Referral Procedures
Forward the following documents to the attention of the Program Manager for Resolution Support Services at the SELPA.
DM 52 – Transfer into District
•
• 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.
3.
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.
CAHELP JPA Referral Procedures
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Revised 8/9/2022
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