Referral and Care Coordination
On this page, you can find examples of referral forms that are compliant with federal Health Insurance Portability and Accountability Act (HIPAA) and Family Educational Rights and Privacy Act (FERPA) privacy and confidentiality requirements, feedback forms to inform primary care providers of the results of evaluations, and referral guidelines. The map shows states that have standardized referral forms.
Legend:
Has standardized referral form (37)
No known form (14)
* Note: Washington, DC is not pictured on the map, but is included in the counts above. It has an education provider referral form to Part C Early Intervention; English and Spanish versions available. English Form. Spanish Form. Found on this page.
Policy Trends
- 37 states (including Washington, DC) have a standardized referral process to facilitate children and families accessing follow up services after identification of need, compared to only 14 in 2016.
- Most states have forms specific to Part C Early Intervention referrals. Forms in 7 states (Arizona, Colorado, Connecticut, Georgia, Minnesota, Oregon, and Vermont) can refer children to a variety of services, including early intervention.
- Referrals in 12 states can now be made online (Arizona, Arkansas, Idaho, Indiana, Maine, Michigan, Minnesota, Missouri, Montana, Ohio, South Carolina, and Tennessee)
- 17 states (Colorado, Hawaii, Illinois, Iowa, Kansas, Maryland, Minnesota, Montana, Nevada, New Mexico, North Carolina, Oregon, Texas, Vermont, Virginia, Washington, DC, and Wisconsin) have a form that enables referral feedback to be sent back to the referring provider.
- 11 states (Arizona, Arkansas, Colorado, Connecticut, Delaware, Missouri, Montana, North Carolina, South Carolina, Texas, and Vermont) have forms for use by a specific type of provider, such as primary care, child care, education, or a state department of human services.
- 4 states (Arizona, Colorado, Oregon, and Washington, DC) have a standardized form available in Spanish.
This information is based on a 2020 NASHP environmental scan. Please email Rebecca Cooper with any updates.