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What is EI Referral Form
The Early Intervention Referral Form is a permission and consent document used by parents, guardians, and providers to refer children for early intervention or early childhood special education services in Oregon.
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EI Referral Form is needed by:
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Parents or guardians looking to initiate early intervention services for their children
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Healthcare providers requiring documentation for child referrals
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Physicians, Physician Assistants, or Nurse Practitioners confirming medical eligibility
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Educators needing to refer students for special education evaluation
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Child development specialists assisting families with referrals
How to fill out the EI Referral Form
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1.Access the Early Intervention Referral Form on pdfFiller by searching for the form in their template library or by uploading a copy if you have one.
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2.Once opened, review the form layout in pdfFiller's intuitive interface, ensuring all sections are clearly visible.
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3.Gather necessary information such as child's name, date of birth, and parent/guardian contact details before beginning to fill out the form.
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4.Start filling in the first section by entering the child's name in the designated field and providing the date of birth in the format requested.
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5.Proceed to complete the parent/guardian contact information, ensuring all details are accurate and current.
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6.Next, address the reason for referral by selecting appropriate checkboxes or writing a brief explanation in the provided area.
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7.Fill in the required provider information, including their name, contact details, and any other necessary credentials.
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8.If applicable, ensure medical condition statements are completed by the licensed physician, physician assistant, or nurse practitioner.
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9.Review each field for accuracy before finalizing the form; seek assistance if you encounter any confusion on the form.
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10.Once the form is completed, utilize pdfFiller's review feature to make any last-minute corrections.
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11.Save your completed form directly on pdfFiller, ensuring it is stored securely for your records.
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12.Download the form as a PDF to keep a local copy or submit it electronically as directed in your referral process.
What are the eligibility requirements for using the Early Intervention Referral Form?
To use the Early Intervention Referral Form, the child must be between birth and age 5, and there should be a concern regarding their development that necessitates a referral for early intervention services.
Are there any deadlines for submitting the Early Intervention Referral Form?
There is no specific deadline for submission; however, timely referrals can expedite access to intervention services. It is advised to submit as soon as developmental concerns are identified.
What methods can I use to submit the form after completion?
After completing the Early Intervention Referral Form, you can submit it electronically through pdfFiller or download it to send via mail or fax to the appropriate location as indicated in your referral guidelines.
What supporting documents are needed when submitting this form?
Typically, you may need to include relevant medical or educational documentation that supports your referral. This could include development assessments or notes from healthcare providers.
What common mistakes should I avoid while filling out the form?
Ensure all fields are filled in correctly, avoid leaving required sections blank, and double-check the spelling of names and dates. Missing information may delay processing.
How long does it take to process the Early Intervention Referral Form?
Processing times can vary based on the organization's workload and the completeness of submitted information. Expect a response within a few weeks following submission.
Is notarization required for the Early Intervention Referral Form?
No, notarization is not required for the Early Intervention Referral Form. However, signatures from parents/guardians and providers are mandatory.
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