Physical Therapy - Initial Referral

Physical Therapy (PT) | Initial Referral

School-based physical therapy (PT) supports the student's ability to gain access to and make progress in the school curriculum. It corrects, facilitates, or adapts to the student's functional performance in motor control and coordination, posture and balance, functional mobility, accessibility, and the use of assistive devices. PT works on compensation (i.e., modifying the environment, tools, or task) to help the child succeed in school.

 

 Pre-Referral

  • Convene an Individualized Education Program (IEP) meeting to document the team's decision to refer the student for a PT assessment.
  • Complete the Physical Therapy Referral form (D/M 120B) and obtain the signatures of the person making the referral and the director of special education.
  • Complete the Authorization for Use and/or Disclosure of Information form (D/M 63) and obtain the parent/guardian signature. Specify the receiving agency as the SELPA.
  • Complete the Assessment Plan form (D/M 66) and obtain the parent/guardian signature.
  • The person making the referral should check the box that corresponds to the type of assessment(s) requested.
  • The parent/guardian should initial each applicable statement listed under the Parental Authorization section of form D/M 66.
  • It's 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.

 

Timeline for Assessment

Within five business days of receipt of the completed referral packet, the Program Manager, Due Process at the SELPA, will review the packet for completion and forward it to the appropriate physical therapist.

Referral

  • D/M 120 Physical Therapy Referral form
  • D/M 63 Authorization for Use and/or Disclosure of information form
  • D/M 66 Assessment Plan form
  • Physician's note with diagnosis
  • 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 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, Due Process 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, Due Process at the SELPA.

Within five business days of receipt of the Addendum to the IEP, the Program Manager, Due Process 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.
 
For more information, please contact our office at (760) 552-6700