Get the free early intervention (ei) referral form - Hawaii State Department of ...

State of Hawaii Department of Health Early Intervention Section (EIS) Oahu: 8085940066 Toll Free: 8002355477 Fax: 8085940073 EARLY INTERVENTION (EI) REFERRAL FORM *Required information for referral

How to fill out early intervention ei referral

How to fill out early intervention ei referral

1. Gather all necessary information including child's name, date of birth, and contact information.
2. Obtain the Early Intervention (EI) referral form from the appropriate agency or organization.
3. Fill out the child's demographic information accurately on the referral form.
4. Provide details about the child's developmental concerns and any specific areas of delay or disability.
5. Attach any relevant evaluation reports or assessments that support the need for early intervention services.
6. Include contact information of professionals or providers who have worked with the child and can provide additional information if needed.
7. Submit the completed referral form through the designated submission process or to the appropriate agency or organization.
8. Follow up with the agency to ensure the referral has been received and to inquire about the next steps in the process.

Who needs early intervention ei referral?

1. Infants and toddlers (up to 3 years old) who have developmental delays or disabilities.
2. Children who have been identified through screening or assessment as needing early intervention services.
3. Children who have a diagnosed medical condition that puts them at risk for developmental delays.
4. Children who require support in reaching their developmental milestones.
5. Families or caregivers who have concerns about their child's development and want to access early intervention services.
6. Children who have experienced early adversity or have been exposed to environmental risks that may impact their development.

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What is early intervention ei referral?

Early intervention EI referral is a process where a child who may be at risk for development delay or disability is referred for services and support at an early age.

Who is required to file early intervention ei referral?

Parents, caregivers, teachers, doctors, or any individual who suspects a child may benefit from early intervention services are required to file an EI referral.

How to fill out early intervention ei referral?

To fill out an early intervention EI referral, you can contact your local early intervention program or service provider to request a referral form. You will need to provide information about the child's development, medical history, and any concerns you may have.

What is the purpose of early intervention ei referral?

The purpose of early intervention EI referral is to identify children who may benefit from early developmental services and support to help them reach their full potential.

What information must be reported on early intervention ei referral?

Information such as the child's name, date of birth, medical history, developmental concerns, and contact information for the individual making the referral must be reported on an early intervention EI referral.