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SOUTHERN REGION Early Intervention Program Referral Form Please complete this form for referring a child to Early Intervention (Part C) if you prefer to do so in writing. Also, please indicate the
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How to fill out early intervention program referral

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How to Fill Out Early Intervention Program Referral:

01
Obtain the necessary referral form from the early intervention program provider. This can typically be found on their website or by contacting their office directly.
02
Begin by filling out the personal information section. This includes the child's name, date of birth, address, and contact information. Ensure that all information provided is accurate and up-to-date.
03
Next, provide details about the child's developmental concerns or delays. This may include information about their speech and language skills, motor skills, social-emotional development, or any other areas of concern. Be as specific and detailed as possible to help the program provider understand the child's needs.
04
If the child has already received evaluations or assessments from other professionals, include copies of these reports or mention them in the referral form. This can provide valuable information to the early intervention program staff and help determine the appropriate services for the child.
05
Indicate any additional information about the child's medical history or any relevant documentation that may assist the early intervention program in understanding the child's needs.

Who Needs Early Intervention Program Referral?

01
Children who demonstrate developmental delays or have concerns in one or more areas of their development, such as speech, motor skills, or cognitive abilities, may require an early intervention program referral.
02
Children who have been assessed by healthcare professionals or educators and have been recommended for early intervention services may also need a referral. This can include children who have been diagnosed with a specific condition or disorder that requires early intervention support.
03
Additionally, parents or caregivers who have concerns about their child's development and believe that early intervention services could be beneficial should seek a referral. It is important to trust your instincts as a parent and seek support for your child if you feel they may benefit from early intervention.
Overall, anyone who believes that a child may benefit from early intervention services should consider seeking a referral. Early intervention programs can provide crucial support and resources to help children reach their full potential in their developmental journey.
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Early intervention program referral is a process where children who may be at risk for developmental delays or disabilities are referred to receive services and support at an early age.
Parents, healthcare providers, educators, or caregivers may be required to file an early intervention program referral if they suspect a child may benefit from services.
You can fill out an early intervention program referral by contacting your state's early intervention program office or by working with a healthcare provider to complete the necessary paperwork.
The purpose of early intervention program referral is to identify children who may benefit from early intervention services to support their development and address any potential delays or disabilities.
Information such as the child's age, developmental concerns, medical history, and contact information for parents or caregivers may need to be reported on an early intervention program referral.
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