Get the free Autism Team Referral Form updated Dec. 2014 - Download .pdf - kidss keystonelearning

Keystone Learning Services ASD Core/Diagnostic Team Referral (Autism Screening, Evaluation, and Intervention) Student Name: Date of Referral: School: DOB: School Contact: Phone: Parent/Caregiver Name:

How to fill out autism team referral form

How to fill out an autism team referral form?

1. Start by carefully reading the instructions provided on the referral form. Make sure you understand what information is being asked for and how to properly fill in each section.
2. Provide your personal information. This typically includes your name, date of birth, address, phone number, and email address. Make sure to double-check your contact details for accuracy.
3. Indicate the reason for the referral. Specify that you are seeking assessment or support related to autism spectrum disorder. Be as clear and concise as possible when explaining your concerns or the symptoms you have observed.
4. Include any relevant medical history or previous evaluations. If you or your child have received any previous assessments or diagnoses related to autism, provide copies of these documents if requested. This can help the autism team gain a better understanding of your situation.
5. Fill out the section regarding developmental milestones. This may ask about important milestones in areas such as communication, social skills, and repetitive behaviors. Provide specific examples or detailed descriptions to help paint a clearer picture.
6. Include information about current challenges or difficulties. Describe any specific behaviors, sensory issues, or communication struggles that you or your child are experiencing. This helps the autism team assess the level of support needed.
7. Provide information about any other professionals involved. If you or your child have been receiving assistance from other healthcare providers, therapists, or educators, include their names, contact details, and brief summaries of their involvement.
8. If applicable, state your preference for specific autism services or therapies. Some referral forms may ask for your preferences or goals when it comes to accessing support for autism. Take the opportunity to express any specific needs or preferences you may have.
9. Finally, review the completed form for any errors or missing information. Ensure that all sections have been appropriately filled out before submitting the referral form.

Who needs an autism team referral form?

1. Individuals who suspect they or their child may have autism spectrum disorder can benefit from utilizing an autism team referral form. This form serves as a way to request assessment or support from a specialized autism team, which typically includes professionals from various disciplines.
2. Parents or caregivers who have concerns about their child's development, including areas such as communication, social skills, or repetitive behaviors, may need an autism team referral form. This form allows them to initiate the process of accessing expert evaluation and intervention.
3. Healthcare providers, educators, or other professionals working with individuals who exhibit signs of autism can also use an autism team referral form. By filling out this form, they can facilitate the appropriate assessments and interventions necessary for better understanding and supporting the person in question.

For pdfFiller’s FAQs

What is autism team referral form?

The autism team referral form is a document used to refer individuals suspected of having autism to a specialized evaluation team.

Who is required to file autism team referral form?

Healthcare providers, educators, or caregivers who suspect an individual may have autism are required to file the autism team referral form.

How to fill out autism team referral form?

The form typically requires information about the individual's symptoms, medical history, and any previous evaluations. It must be filled out accurately and submitted to the appropriate evaluation team.

What is the purpose of autism team referral form?

The purpose of the autism team referral form is to facilitate the evaluation and diagnosis of individuals suspected of having autism, leading to appropriate interventions and support.

What information must be reported on autism team referral form?

Information such as the individual's demographics, symptoms, medical history, and any previous evaluations must be reported on the autism team referral form.

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