Get the free Early Intervention Referral Form - King County - kingcounty

How to fill out early intervention referral form

How to fill out an early intervention referral form:

1. Start by gathering all the necessary information. The referral form may require personal details such as the child's name, date of birth, and contact information.
2. Provide information about the child's developmental concerns or delays. Include specific details about the areas in which the child may require assistance or support.
3. Mention any previous evaluations or assessments that have been conducted on the child. This information helps the early intervention team understand the child's background and current needs better.
4. Include any medical or health-related information that may be relevant to the child's development. This could include details about existing diagnoses, medications, or ongoing therapies.
5. If applicable, provide information about the child's educational setting, such as the current school or early learning program they are attending.
6. Make sure to sign and date the referral form before submitting it.
7. Keep a copy of the referral form for your records, as it might be useful for future reference.

Who needs an early intervention referral form?

1. Children who are experiencing developmental delays or have concerns about their development may require an early intervention referral form.
2. Parents or caregivers who notice that their child may need additional support to meet their developmental milestones can request the form.
3. Healthcare professionals, including doctors, pediatricians, or therapists, may also need to fill out an early intervention referral form if they suspect a child requires specialized services.
4. Early learning programs or schools may request a referral form if they believe a child would benefit from early intervention services to support their educational progress.

Remember, it's always important to consult with professionals and follow the specific guidelines provided by your local early intervention program or healthcare provider when filling out an early intervention referral form.

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What is early intervention referral form?

The early intervention referral form is a document used to refer a child suspected of having developmental delays or disabilities to receive services and support at an early age.

Who is required to file early intervention referral form?

Healthcare providers, educators, caregivers, and parents are required to file the early intervention referral form if they suspect a child may have developmental delays or disabilities.

How to fill out early intervention referral form?

The early intervention referral form can be filled out by providing the child's personal information, medical history, and any concerns or observations about the child's development.

What is the purpose of early intervention referral form?

The purpose of the early intervention referral form is to identify children who may benefit from early intervention services to support their development and improve outcomes.

What information must be reported on early intervention referral form?

The early intervention referral form typically requires information such as the child's name, age, medical history, developmental concerns, and contact information for the referring party.