Bow RiverRCSD:PHYSIOTHERAPYSCREENING
Thisformneedstobecompleted/sentwithanynewrequestsforPhysiotherapyconsultativesupports.
STUDENTNAME:
SCHOOL:
P.E. Schedule – Day: Time: PE Teacher:
Level 1(HIGH)
PriorityLevel 1
HIGHNEEDS
PriorityLevel2
MEDIUMNEEDS
PriorityLevel3
LOWNEEDS
PriorityLevel4
VeryLowNeeds
PriorityLevel(RefertoChartBelow)
Level2(MEDIUM) Level3(LOW) Level4(VERY LOW)
-Children whoare medicallyunstable;wheelchairusers; requireseating/positioning
-FulltimeEducationAssistantinplace
Predictedsupportsmayinclude:
-Initialvisitatthebeginningoftheschoolyear
-1-3visitstotrainEducationAssistant(transfers,lifting,stretching,etc)
-1-4individualvisitsregardingneedforandproperfitofequipment
-2-3visitsfocusedonclient(includinghomeorcommunityvisitifrequired)
-Children whoare medicallystable,haveneedsforaccesstotechnologyorequipmentfor classroomandhome,andrequiresomeassistancewithtransfersand/ormobility
-Afullorpart-timeEducationAssistantisinplace
Predictedsupportsmayinclude:
-Initialvisitatthebeginningoftheschoolyear
-1-2visitsforprogramdevelopmentandfollow-up
-1-3visitstomonitordevelopmentorconsulttotheschool,homeorcommunity
-Children withfunctionalgrossmotordelays; mayincludesomechildrenwithstable neurologicalconditions
-EducationAssistantinplace(mayincludesmallgroup)
Predictedsupportsmayinclude:
-Targetedsupportsandresourcesharing;directaccesstoPTcannotbeabaseexpectationfor student'satthislevel
-Children whomayhavefunctionalgrossmotordelaysbutareindependentintheschool environment; mayincludechildrenwithknown/suspectDCD
-StudentmayormaynothavesupportsfromanEducationalAssistant
Predictedsupportsmayinclude:
-Universalschool-basedlearningsupportsandresources;targetedsupportsasneeded
-DirectaccesstoPTcannotbebaseexpectationforstudent'satthislevel.
Requeststothe BRCSDPhysiotherapist mustbeforaddressingspecificfunctional problem(s)that impactsthestudent'sabilitytoparticipate in the educationalenvironment.Issuesofhealthandsafety(studentandstaff),positioning,mobility,andstudent'swithequipmentwillalwaysreceivefirst priority.ThePhysiotherapistcanbestassistyouandaddressyourreferralifyouareasspecificaspossibleinyourconcerns.
Pleasenote:TheexistenceofadiagnoseddisabilityorthefactthatthechildatonetimereceivedPhysiotherapyisnot initselfareasonforreferral.