Get Referral Medical For Home Instruction - Los Angeles Unified School Bb

Filling out the Referral Medical For Home Instruction form is an essential step in securing educational support for students unable to attend school due to medical reasons. This guide provides a step-by-step overview to assist users in completing this form accurately and efficiently online.

Follow the steps to complete the form successfully.

1. Click the ‘Get Form’ button to access the referral form and open it in the online editor for convenient filling.
2. Provide the student’s last name and first name in the designated fields to ensure proper identification.
3. Select the appropriate box to indicate the student's gender, using 'M' for male and 'F' for female.
4. Enter the student's date of birth in the format MM/DD/YYYY, followed by their grade level.
5. Fill in the student’s address, city, and ZIP code to confirm their residential details.
6. Record phone numbers for home, cell, and work contacts to facilitate communication.
7. Complete the parent or guardian's name and language preferences for future correspondence.
8. Identify the cumulative record carrying school along with its phone number.
9. Indicate the student's last date of attendance to provide historical context.
10. Confirm whether the student has a current Individualized Education Plan (IEP) or 504 Plan by selecting 'Yes' or 'No'.
11. Review the implementation of service section, understanding the responsibilities of both the parent/guardian and the service provider.
12. Sign and date the authorization to receive or release medical and academic information.
13. Ensure a California licensed physician completes the second page of the form, providing a medical diagnosis and expected return date.
14. Once all sections are filled out, save your changes, and you can choose to download, print, or share the completed form.

Begin completing your Referral Medical For Home Instruction form online today.