Referral Information - Client Case

Purpose: The Referral Information section of an EI Client Case contains the following fields:

1. Referral Date – Calendar – This date auto populates from the associated referral case

   1. Children who transfer from another EIB - this initial referral date will retain. CCB Transfer Date is tracked within the Client Information Section Late Referral? – Checkbox - This is prepopulated to true if the initial referral date is within 45 days of the child’s transition age

2. Referral After 2.6? – Checkbox - True when Referral Date is 6 months before child’s 3rd birthdate. Field is display only

3. Referral Source – The following picklist options available:

   1. CCB - selected for in-state transfers. Users will need to select the original referral source

   2. Child Care

   3. Early Head Start/ Head Start

   4. Home Visiting Program

   5. Hospital/ Practice

   6. Other

   7. Primary Care Physician

   8. Public Health

   9. Relative

   10. Self - (Parent(s)/Legal Guardian) Users will be prompted to select how the parent knew to refer to EI

   11. Service Provider

   12. Social Services

   13. Early Childhood Council

   14. Child Welfare/CAPTA- If the referral came directly from the child welfare caseworker

   15. EI State Office/CAPTA - If the referral was sent from the EI team

       Note: If the referral source is Hospital/Practice or Primary Care Physician then the Hospital/Practice or Primary Care Physician is required to be entered

4. Self-Referral Source

   1. Self - Nobody prompted them to call and make a referral

   2. Physician - Primary physician encouraged the family to make a referral

   3. Relative

   4. Website

   5. Community Partner – E.g.: childcare, neighbor, school, etc.

5. Original Referral Source

6. Referral Name

7. Hospital/Practice - Look up

8. Primary Care Physician - Look up

9. Record Type - This is prepopulated based on the client record. If the record type does not read Early Intervention

10. Follow-up by Case Worker - checkbox

11. Secondary Referral ID

12. Referral Origin