Referral methods to RCEB for Eligibility Determination for Children under Age 3 residing in Alameda and Contra Costa Counties:
CALL THE EI INTAKE REFERRAL LINE
1) Parents or anyone making a referral may contact the EI Intake Referral Line at (510) 618-6195. A recorded message will prompt you to leave a message with the following information: your name and contact information, relationship to child being referred, child’s name [spelling for accuracy], DOB, address where child lives, and indicate the concern or reason for referral. Also, copies of the child’s current medical records and any medical records relating to the presenting developmental delay concern should be provided. Records of any evaluations that may have occurred are needed. Information can be faxed to: (510) 618-7763, ATTENTION: EI INTAKE [Please be aware that if child is determined eligible for Early Start Services, California law requires parents to contact their medical insurance provider to access the therapy treatment [occupational, physical, or speech therapy] that may be recommended for the child. To expedite this requirement, you may want to consult with your medical insurance provider now to request if these types of therapy are available in your medical services plan.]
FAX OR MAIL DOCUMENTS:
1) When using the Early Start/Prevention Program referralform, all sections relevant to the child should be completed.
2) Anyone can make a referral, but the parent or legally responsible person for the child must consent to referral.
3) If child is in foster placement, provide official documents identifying who holds educational rights for the child being referred.
4) If child has been adopted, official documents verifying adoption status should be provided.
5) At initiation of your discussion of referral with parent or person legally responsible for child, a release of information using your own practice, clinic, or agency form should be completed and signed by the parent or person legally responsible.
6) In your discussion of referral for eligibility determination, it would benefit parent to be informed that if child is determined eligible for Early Start Services, California law requires parents to contact their medical insurance provider to access the therapy treatment [occupational, physical, or speech therapy] that may be recommended for the child. To expedite this requirement, they may want to consult with their medical insurance provider now to request if these types of therapy are available in their medical services plan.
7) With your release of information form, you should provide supporting documentation related to child’s current concerns for developmental delay: birth/discharge records [significantly important for children presenting with established risk conditions, and/or medical risk factors], medical records related to current health status, and all relevant evaluations that may have been completed.
8) If using a developmental screener, such as the ASQ3 or ASQ-SE, please complete and send all pages; do not send a summary of your interpretation and/or only the scoring page
Fax completed referral document and medical records: (510) 618-7763 ATTENTION: EI INTAKE or
Mail referral document and medical records to RCEB 500 Davis Street, Suite 100, San Leandro, California 94577 ATTENTION: EI INTAKE
Delays may occur when:
1) A referral source provides an abbreviated summary or interpretation of child’s medical record in lieu of the complete medical records relevant to the presenting concerns.
2) There is insufficient information provided in order to contact the child’s parent, i.e. no name, no phone number, no address.
3) Proper documentation is not submitted related to who holds educational rights for a child in foster placement
San Leandro (Main Office): 500 Davis Street Suite 100 San Leandro CA 94577 Tel: 510 618.6100 Fax: 510.618.7763
Concord: 2151 Salvio Street Suite 365 Concord CA 94520 Tel: 925 798.3001 Fax: 925 674.8001
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