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Assistive Technology Referral Form Communication Students Name: Completed by: (SLP) Speech and Language Assessment Articulation Tests Date Test Results Phonological Test Date Test Results Receptive

How to fill out assistive technology referral form

How to fill out assistive technology referral form:

1. Begin by gathering all necessary information. This may include the person's name, contact details, age, gender, and any relevant medical history or documentation.
2. Next, carefully review the instructions provided on the assistive technology referral form. Make sure you understand the purpose of the form and the information it requires.
3. Start filling out the form by entering the individual's personal information. This may include their full name, date of birth, address, phone number, and email.
4. Move on to the section that requires information about the person's medical condition or disability. Be as specific and accurate as possible, providing details about their diagnosis, symptoms, and any relevant treatments they have undergone.
5. If there are any specific assistive technology devices or services that the person requires, make sure to note them down on the form. This can include items such as hearing aids, wheelchair, vision aids, or speech-to-text software.
6. Don't forget to include any additional information or comments that may be relevant to the referral process. This could be insights from healthcare professionals, recommended assistive technology solutions, or any other important details that could assist in the evaluation process.

Who needs assistive technology referral form:

1. Individuals with disabilities or medical conditions that require assistive technology to improve their quality of life or independence.
2. Healthcare professionals who are part of the person's care team and are involved in the evaluation and recommendation of assistive technology devices or services.
3. Educational institutions or organizations that aim to provide appropriate assistive technology to students or individuals with disabilities.

In summary, filling out an assistive technology referral form involves gathering all necessary information, following the provided instructions, and accurately documenting the individual's personal details, medical condition, and specific assistive technology needs. The form is needed by individuals with disabilities, healthcare professionals, and educational institutions to ensure the appropriate provision of assistive technology solutions.

For pdfFiller’s FAQs

What is assistive technology referral form?

Assistive technology referral form is a document used to request specialized technology or equipment to help individuals with disabilities.

Who is required to file assistive technology referral form?

The individual with a disability or their caregiver is required to file the assistive technology referral form.

How to fill out assistive technology referral form?

To fill out the assistive technology referral form, the individual or caregiver must provide personal information, details of the disability, and the specific technology or equipment needed.

What is the purpose of assistive technology referral form?

The purpose of the assistive technology referral form is to ensure that individuals with disabilities have access to the necessary technology and equipment to improve their quality of life and independence.

What information must be reported on assistive technology referral form?

The assistive technology referral form must include personal information, details of the disability, medical records, and a description of the needed technology or equipment.

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