Referral Information Profile

This profile is designed to collect and convey referrals for services and support information.

The Referral Information Profile is crucial in guiding decisions regarding further evaluations or developing an Individualized Education Program (IEP) for students who qualify for special education services. Additionally, it ensures that all pertinent information is considered when planning interventions or accommodations.

The form consists of nine fields in total. The first four fields are mandatory and establish the workflow from the Referral Profile to the creation of the Evaluation or Reevaluation Notice.

Field Name	Description	Data Flow	Source
Student	Name of the student for whom the meeting has been called.	In	NA
Date of Referral	The date on which this evaluation or referral was proposed.	Out	NA
Type of Referral	Type of evaluations for which the student has been referred. The drop-down shows the following options. (none) First Steps Initial Evaluation Initial Expedited Evaluation Initials following a lack of progress in response to interventions Move-in Review Reevaluation Review	Out	NA
Source of Referral	The person who has recommended the evaluation or referral.	Out	NA

Field Name	Description	Data Flow	Source
Referral Decision	Final decision about the referral.	Out	NA
Date of Notice of Evaluation	The date on which this final response was given.	Out	NA
Parent Consent Response	Parent’s or Guardian’s response about giving consent for this evaluation or referral.	Out	NA
Parent Consent Date	The date on which this consent response was given. Note: A Parent or Guardian has the authority and privilege over the consent. They can give consent and later withdraw it. They can initially deny and later agree. In either case, the system will always consider the latest consent status and the date it was given.	Out	NA
Additional Information	Lists all other details regarding the case that might need to be captured.	Out	NA