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Gulfport School DistrictRevised 6.20.17Referral for SchoolBased Physical/Occupational Therapy Evaluation STUDENT: ___ TYPE OF REFERRAL:___PHYSICALHAS STUDENT PREVIOUSLY RECEIVED OT AND/OR PT?___OCCUPATIONAL

How to fill out referral for school-based ot-pt

How to fill out referral for school-based ot-pt

1. Obtain a referral form from the school's special education department or the student's primary care physician.
2. Fill out the student's personal information including name, date of birth, and contact information.
3. Provide details about the student's medical history, current diagnosis, and any relevant medical concerns.
4. Include information about the specific occupational therapy or physical therapy services required by the student.
5. Obtain any necessary signatures from the student's parent or guardian and relevant healthcare providers.
6. Submit the completed referral form to the school's special education department or healthcare provider for review and approval.

Who needs referral for school-based ot-pt?

1. Students who have been identified with physical or developmental disabilities that impact their ability to participate in school activities.
2. Students who have been referred by their primary care physician for occupational therapy or physical therapy services to address specific medical concerns.

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What is referral for school-based ot-pt?

A referral for school-based occupational therapy and physical therapy (OT-PT) is a formal request for evaluation and services for students who may need support in their physical or functional abilities to participate in school activities.

Who is required to file referral for school-based ot-pt?

Referrals for school-based OT-PT can be filed by teachers, school nurses, special education personnel, or parents/guardians of the student.

How to fill out referral for school-based ot-pt?

To fill out a referral for school-based OT-PT, one must include the student's personal information, specific concerns related to the student’s abilities, observations of difficulties in school activities, and any relevant medical history that may impact their OT-PT needs.

What is the purpose of referral for school-based ot-pt?

The purpose of the referral for school-based OT-PT is to identify students who require additional support to enhance their ability to participate in educational settings, thereby promoting their overall academic success and well-being.

What information must be reported on referral for school-based ot-pt?

The referral must report the student's name, age, grade, specific areas of concern, previous interventions attempted, and any assessments already conducted relevant to the referral.