Get the free Assistive Technology Referral Form - Nsseo.org - nsseo

Northwest Suburban Special Education Organization 799 W Kensington Road Mount Prospect IL 60056-1111 Sue Mahoney, M.A., CCC-SP/L, Assistive Technology Coordinator 847-463-8142 Fax: 847-463-8196 TDD:

How to fill out assistive technology referral form

How to fill out an assistive technology referral form:

1. Start by gathering all the necessary information: Make sure you have the person's name, contact information, medical history, and any relevant documentation.
2. Begin with the personal details: Fill in the person's name, date of birth, address, and phone number. This information will help identify the individual who needs the assistive technology.
3. Provide the medical information: Include any relevant medical diagnoses, disabilities, or conditions that require assistive technology. This could include information about physical limitations, sensory impairments, or communication difficulties.
4. Describe the specific needs: Clearly explain the functional limitations or challenges that the individual faces and how assistive technology can help address these issues. Be detailed and specific to ensure a proper assessment.
5. Include information about previous assessments or interventions: If there have been previous assessments or attempts to provide assistive technology, mention them in this section. This will provide a comprehensive background for the referral process.
6. Provide supporting documentation: Attach any relevant medical reports, evaluations, or assessments that support the need for assistive technology. This will strengthen the referral and help the assessors make an informed decision.
7. Contact information: Include the contact details of the referring person or organization, including name, address, phone number, and email address. This will allow the assessors to reach out for any additional information if needed.

Who needs an assistive technology referral form?

1. Individuals with disabilities: People who have physical, sensory, cognitive, or communication disabilities may require assistive technology to help them overcome limitations and improve their quality of life.
2. Caregivers and family members: Referral forms may also be filled out by caregivers or family members who are seeking assistive technology on behalf of the person with a disability. They play an essential role in advocating for the needs of their loved ones.
3. Healthcare professionals: Doctors, therapists, or other healthcare professionals who have assessed a person's needs and determined that assistive technology would be beneficial may initiate the referral process. They can provide valuable input and expertise in filling out the form.

In summary, filling out an assistive technology referral form involves gathering relevant information, providing personal and medical details, describing specific needs, including supporting documentation, and providing contact information. The form is needed by individuals with disabilities, their caregivers, family members, and healthcare professionals involved in the assessment process.

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What is assistive technology referral form?

Assistive technology referral form is a document used to request assistive technology services or equipment for individuals with disabilities.

Who is required to file assistive technology referral form?

Individuals with disabilities or their caregivers are required to file the assistive technology referral form.

How to fill out assistive technology referral form?

To fill out the assistive technology referral form, individuals need to provide personal information, details about their disability, and the specific assistive technology services or equipment they are requesting.

What is the purpose of assistive technology referral form?

The purpose of the assistive technology referral form is to facilitate the process of obtaining assistive technology services or equipment for individuals with disabilities.

What information must be reported on assistive technology referral form?

The assistive technology referral form must include personal information, details about the disability, and the specific assistive technology services or equipment requested.