Special Health Care Services - Initial Referral

Special Health Care Services | Initial Referral

Special health care services are available for students who have special health care needs.

 

 Pre-Referral

  • Convene an Individualized Education Program (IEP) meeting to document the team's decision to refer the student for special health care services.
  • Complete the Special Health Care Services Referral form (D/M 148) 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's name, if known. If not, leave the field blank.

 

Referral

Forward the following documents to the attention of the Program Manager, Due Process at the SELPA.

  • D/M 148 Special Health Care Services Referral form
  • D/M 63 Authorization for Use and/or Disclosure of Information form
  • IEP or IEP Addendum dated within one year of the referral for special health care services
  • Current Summary of Treatment Plan
  • Treatment Plan must be signed by physician and parent/guardian
  • Treatment Plan must include diagnosis
  • Treatment Plan must specify health care need required
  • Treatment Plan must specify medication type and dosage
  • Treatment Plan must specify administration instructions
  • Any additional supporting information

 

Timeline for Services

Within five business days of receipt of the completed referral packet, the Program Manager, Due Process at the SELPA will develop an Individual Service Agreement (ISA) and forward it to the appropriate Nonpublic Agency (NPA) for signature.

Upon receipt of the signed ISA, the SELPA will forward the referral packet to the appropriate NPA. The agency will contact the person who signed the referral to coordinate and begin services. The SELPA will enter the services into the SELPA Management Information System (MIS) database.

For more information, please contact our office at (760) 552-6700