Get the free Assistive Technology Referral Form - ESU 2

SoutheastAssistiveTechnologyReferralForm CoveringEducationalServiceUnits2,3,4,18,&19 DateofReferral EU District Building Referral from Title Email Phone Students name Dateofbirth Grade Parent(s) Address

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. This may include personal details such as name, address, contact information, and date of birth.
2. Identify the purpose of the referral. Determine why the individual needs assistive technology and specify the type of support required, such as mobility aids, communication devices, or assistive software.
3. Provide relevant medical or educational information. This may involve sharing diagnoses, functional limitations, and any previous assessments or evaluations conducted.
4. Include details about current services and supports. Specify any existing assistive technology devices or services the individual already uses and describe their effectiveness.
5. Note any specific goals or outcomes desired from using assistive technology. This could involve improving communication skills, increasing independence, or enhancing overall well-being.
6. Describe the environment in which the assistive technology will be utilized. Provide information about the individual's living situation, school or workplace settings, and any potential challenges or barriers that may need to be addressed.
7. Document any preferences or unique considerations. Take into account the individual's preferences, cultural background, language needs, or sensory sensitivities to ensure appropriate assistive technology recommendations.
8. Consider the individual's financial resources and insurance coverage. If applicable, provide information about insurance plans, funding sources, or any financial assistance programs that could help support the acquisition of assistive technology.

Who needs an assistive technology referral form:

1. Individuals with disabilities who require assistive technology to enhance their independence, communication, mobility, or overall quality of life.
2. Patients referred by healthcare professionals, therapists, educators, or other specialists who have identified a need for assistive technology in their care.
3. Students with disabilities who may require assistive technology in educational settings to access curriculum, participate in activities, or achieve academic success.

Remember, the assistive technology referral form serves as a crucial document to ensure that individuals with disabilities receive appropriate and beneficial assistive technology supports tailored to their unique needs and goals.

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What is assistive technology referral form?

Assistive technology referral form is a document used to refer individuals who may benefit from assistive technology devices and services.

Who is required to file assistive technology referral form?

Healthcare professionals, educators, and caregivers are required to file assistive technology referral forms.

How to fill out assistive technology referral form?

To fill out the assistive technology referral form, one must provide detailed information about the individual in need of assistive technology, along with the specific devices or services being requested.

What is the purpose of assistive technology referral form?

The purpose of the assistive technology referral form is to ensure that individuals with disabilities receive the appropriate assistive technology devices and services to help them lead fulfilling lives.

What information must be reported on assistive technology referral form?

The assistive technology referral form must include information about the individual's medical history, current needs, and any relevant assessments or evaluations.