Get Soonerstart Early Intervention Program Referral Form - Ok

Completing the SoonerStart Early Intervention Program Referral Form - Ok online is an essential step in supporting the developmental needs of your child. This guide provides clear instructions to help you fill out the form accurately and efficiently.

Follow the steps to complete the referral form online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin with Section 1, which requires child information. Fill in the first name, middle initial, and last name of the child. Then, include the date of birth, age, and indicate if the child is in DHS custody. For ethnicity, select 'yes' or 'no' for Hispanic or Latino status, and fill in the sex and social security number. If the child has a Medicaid number, enter it. If there is no Medicaid number, mark 'potentially eligible' with 'yes' or 'no' for further options regarding race.
3. Proceed to Section 2 for family information. Provide the names of the caregivers along with their relationship to the child, cell phone numbers, and indicate if the phone is ‘Home’ or ‘Work’. Add details for an additional contact including their relationship and phone type. Fill in the address, city, state, zip, email, county, and school district. Specify the native language spoken and whether the family needs an interpreter by selecting 'yes' or 'no'.
4. In Section 3, outline the referral information. State the reason for the referral and the date it was made. Enter the service coordinator's name as well as who received the referral and the date it was assigned. Specify the IFSP target date and the SoonerStart site. Provide the referral source's name and title, agency, address, and phone number. Lastly, answer if the parents are aware of the referral with 'yes' or 'no' and indicate how the referral source learned about SoonerStart.
5. After completing all sections, review the form for accuracy. You may then save your changes, download the form for your records, print it for mailing, or share it as needed.

Complete your documents online today to ensure timely support for your child.