OH: PR-04 – Referral for Evaluation
Ohio Form OP-4: Referral for Evaluation IEPPLUS
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OH: PR-04 – Referral for Evaluation TABLE OF CONTENTS OVERVIEW ............................................................................................................................................................................................ 3 FORM INSTRUCTIONS ....................................................................................................................................................................... 3 FORM CREATION ..................................................................................................................................................................................................... 3 Step 1 – Select A Student ............................................................................................................................................................................ 3 Step 2 – Select Options ................................................................................................................................................................................ 4 NAVIGATION/TOOLBAR ......................................................................................................................................................................................... 4 CODE TABLE SETUP ................................................................................................................................................................................................ 5 DATA MAPPING................................................................................................................................................................................... 8 ‘MAIN’ SECTION ....................................................................................................................................................................................................... 8 ‘EDUCATIONAL HISTORY’ SECTION ...................................................................................................................................................................... 9 ‘BACKGROUND INFORMATION’ SECTION ...........................................................................................................................................................10 REVISION HISTORY: ........................................................................................................................................................................ 13
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OH: PR-04 – Referral for Evaluation OVERVIEW The Referral for Evaluation form is a document that documents information for a student that is being referred to Special Education such as demographic information, date of the referral (the form create a Referral Record in IEPPLUS), date of parental consent, education information and health information. FORM INSTRUCTIONS FORM CREATION The form creation process includes the following steps: Step 1: Select a Student Step 2: Select Options STEP 1 – SELECT A STUDENT 1. Click Student Management > Manage an Existing Student. 2. Use the Search window to find the student based on either, Last Name, First Name or Student ID.
3. Click Search. Then click the appropriate Name to select a student. 4. Once a student has been selected, the student’s name, student ID, birth date, and age will display. The forms that can be created for a student will also be listed. Click on the ‘Referral for Evaluation’ link.
The ‘Referral for Evaluation Summary’ screen will display, listing any prior forms created for the student. The most recent form will display at the top of the list. To review an existing form, click the appropriate link. To create a new form, click the ‘New’ icon.
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OH: PR-04 – Referral for Evaluation STEP 2 – SELECT OPTIONS 1. When the ‘New’ button is selected (see screenshot above), the Form Wizard displays. This wizard is an automatic template that helps the user to easily setup the form (see screenshot below).
2. There are 2 options to create the form: • Option #1 – Create a new Referral. Click the radio button to the left of this option, enter a new Referral Date, and select a Referral Type. • Option #2 – Select an existing Referral. Click the radio button to the left of this option, and select an existing Referral record from the drop-down box. 3. Select a Letterhead (optional). 4. When done, click the “Create Form” link. The user also has the option to click ‘Cancel’ as well to clear the form. If this is chosen, then the form wizard will return the user back to the ‘Referral for Evaluation Summary’ screen.
NAVIGATION/TOOLBAR Once the form has been created, it will display a toolbar on the left side of the screen, divided into the following areas: 1. Sections This displays the Main, Educational History, Background Information, and View All sections of the form. Clicking on any one of these sections will bring the user to that specific section. 2. Maintenance These options will maintain Form Information, and Delete. Form Information provides the ability to change the Form Name, Form Date Range, Letterhead, and Referral. Delete functionality is available, depending on the user’s security. SunGard K-12 Education Copyright © 2013
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OH: PR-04 – Referral for Evaluation
3. Validation These options will change the status of the form (Ready for Review, Lock, and Finalize). 4. File Attachments Click the plus icon (+) to add an attachment. Click the minus icon to delete an attachment. 5. Archives Archives are permanent PDF copies of the form. Click Finalize in the Validation section to create an Archived copy. The form should be finalized and archived only after it has been fully completed and a copy has been sent home to the student’s parents or guardians. The following options will always display at the top and bottom of the form:
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Save Information from each section should be saved before moving to another section.
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Return Click the Return icon to return to the Form Summary screen.
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Print Preview Print Preview will display the form in Adobe Acrobat. Mouse over the bottom of the form preview to see the toolbar illustrated below. Select the Print icon or click the Save icon to save a copy of the form to your computer. The plus (+) icon will enlarge the preview for ease of viewing.
CODE TABLE SETUP 1. Navigate to Maintenance > Manage Code Tables. 2. Select the name of the table from the drop down list (ex: “Referral Reason”).
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OH: PR-04 – Referral for Evaluation
3. To add a code, choose the ‘New’ icon from the top menu. 4. Enter the Description in the yellow box, then click on the ‘Update’ link, and then click the ‘Save’ icon from the top menu.
5. To add or edit an Alternate Code, first click ‘Show Alternate Codes’ at the top of the page. Then click Edit on the applicable Code record to open the record for changes.
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OH: PR-04 – Referral for Evaluation
Once the record is open, click the appropriate link to add a new Alternate Code or Edit an existing one. Clicking the ‘Delete’ icon will remove an existing Alternate Code. When finished with the changes, click the ‘Save’ icon.
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OH: PR-04 – Referral for Evaluation DATA MAPPING ‘MAIN’ SECTION
A
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14a 14b 14c
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OH: PR-04 – Referral for Evaluation ‘EDUCATIONAL HISTORY’ SECTION
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OH: PR-04 – Referral for Evaluation
‘BACKGROUND INFORMATION’ SECTION
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OH: PR-04 – Referral for Evaluation
A
1 2-3 4 4 5 6 7 8 9 10 11 12
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IEPPLUS OH: Form PR-04 – Referral For Evaluation Letterhead Maintenance, Manage Letterheads • Use Options, Set System-wide OR My Options defaults • Include Report Headers 1 & 2 • Form Date • Footer on every page Section: Main Student Name Student, Demographic, Name • First, Middle, Last name, Qualifier Student Address Student, Basic Information, Address, Home • Street, City, State, ZIP Code Date of Birth Student, Demographics, Birth Date Student Phone Student, Basic Information, Communication ID Number Student, Demographics, Student ID Gender Student, Demographics, Gender Grade Student, Enrollment, Grade (as of Referral Date) Building Student, Enrollment, Location (as of Referral Date) Present Teacher(s) Multiple staff lookup and free-form text Student’s Native Language Student, Basic Information, Demographics, Language • If not = English, then displays language Parent’s Native Language Student, Basic Information, Contacts, Parent/Guardian, Language • If not = English, then displays language Parent/Guardian/Surrogate Student, Basic Information, Contacts, Type = Parent, Guardian, or Information Surrogate. • Name, Street, City, State, ZIP Code Communications Student, Basic Information, Contacts, Communications • Home Phone, Work Phone, Cell Phone, Email, etc. Reason for Referral Select from Student, Referral, Reason(s) = Alt Code = ‘IR’ • Enable text box and/or display text previously entered for this referral. • Referral Notes not entered through the webform will come into the form. • Upon saving in the form (or user will remove), it will be saved with ‘Referral Reason’ Receive Consent Yes / No question. • Enables Referral Consent Date and Outcome Fields • This field does not print on the report Consent Date Date Field • Saves data to Referral Consent Date field • This field does not print on the report Consent Outcome Referral Result/Outcome drop-down. • Saves data to Referral Outcome field. • This field does not print on the report Section: Educational History Progress Data Text box Intervention Data Text box Trend Data Text box Number of Districts attended Number field Years at present building Number Field
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OH: PR-04 – Referral for Evaluation 20 21 22 23 24 25 26
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Schools, earyl childood Programs, and dates Attendance Age-Appropriate Grade Level
Text Box
Check Box Control Yes / No Check Box Control Section: Background Information Health Data Check Boxes: Vision and/or Hearing Check Boxes: Glasses and/or Hearing Aid(s) Health/Developmental/Physical Check Boxes (Yes/No) Environmental Factors Text Box Preschool Only Check Boxes: • Eating • Dressing • Toileting • Attention • Receptive Communication • Expressive Communication • Hearing • Cognitive • Fine Motor • Play • Gross Motor • Vision • Social/Emotional Behavior • Other Pertinent Inforamtion Text box Signatures: Person Initiating Text box becomes drop-down list if existing staff record is available. Referral Signatures: Drop-down box for position/relationship selection. If existing Position/Relationship to position is selected (field #28 above), it will automatically fill the Student position. If no position is found, then the user can select any position from the drop-down list. Signatures: Date Form Start Date User is able to change the date on the form if needed.
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OH: PR-04 – Referral for Evaluation REVISION HISTORY: 6/3/2013: • Updated entire document’s formatting to conform to standard SunGard QA documentation layouts. • Added: ‘Overview’ section, ‘Form Instructions’ section, ‘Navigation/Toolbar’ section, ‘Code Table Setup’ section, cover page, table of contents, header, footer, and section breaks. • Updated: Screenshots, and ‘Data Mapping’ section & table. 6/21/2011: • Addition of Receive Consent, Consent Date & Outcome to Main page of this form. It does not print on the report.
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