Referral Process

Q: What is the role of the MD in eligibility for special education referrals, testing, etc.?

A: In general, the physician can best help his/her patient by providing a detailed medical history, including specific health problems, behavioral issues, or learning issues that may interfere with the child's ability to benefit from his/her education.
Q: What information would be helpful?

A: Detailed information addressing the impact of the child’s health condition or disability on his/her ability to learn, attend and behave in the classroom, care for themselves in age-appropriate fashion, and their need for special dietary or medical interventions, such as medications, equipment, or other aids. The documented details you provide will help determine your patient's eligibility for Special Education, and may be instrumental in the development of his/her education plan, including special dietary, personal care and medical requirements.
Q: What is the best way to provide documentation?

A: Documentation of the specific health problems, behavioral issues, or learning issues, provided to the parent, are the most helpful. Recommendations on a prescription pad without supplemental information are least helpful. For a sample form, see: Medical Home to School Summary Form (PDF Document 40 KB).


Q: What are the placement options?

A: The LEA provides a continuum of placement from receiving services in general education classrooms to receiving services in separate special schools. It is the goal for students with disabilities, including students in public or private institutions, to be educated with students who are not disabled. This is called the Least Restrictive Environment. Program decisions are made by the IEP team. For more information see: Student Placement and Section 504, US Dept. of Education.

Related Services

Q: What are the related services offered by the school?

A: The following services may be provided by school districts to assist eligible students to benefit from special education and may include: counseling, occupational therapy, physical therapy, speech therapy, recreation therapy, adaptive physical education, nursing services, and other therapies, as decided by the IEP team. For a more complete list see: IDEA Definitions.
Q: How does an eligible student access various therapies and related services (physical, occupational, speech, transportation etc.)?

A: The access is determined by the IEP team, which includes the parent.
Q: What is available for a child with transportation needs?

A: Transportation requirements are considered by the IEP team if a student with a disability cannot benefit from special education without transportation help.

State Rules

Q: What resources are available?

A: There is variation among different states, but there are minimum standards for medication administration in school; immunizations; vision, hearing and spinal curvature screening; and other health and safety policies. For information about your state, see: State Education Contacts and Information.
Q: What is needed to enable a child to take medication at school?

A: Although policy on this varies by state, the detailed information you provide on your referral will be discussed by your patient's IEP team and, if appropriate, incorporated into his/her health care plan, which is developed by the school nurse.

Coordinating Service

Q: How can I help the child who has been sick return to the classroom?

A: The medical team should provide documentation to the parent of the medication plan (side effects, schedule, etc.), release to return to school, treatment plans, and other relevant information.
Q: What is the best way to collaborate with the school system to optimize management of medical problems?

A: A liaison from the treatment team can help school personnel through telephone contacts and in-service programs. The parent should ensure that the school has current and relevant information listed on the school’s emergency contact form. The following is a suggested communication checklist of issues for education personnel:
  • Diagnoses and treatment;
  • Factors affecting attendance:
    • frequency of outpatient visits,
    • frequency/duration of inpatient treatment, and
    • fatigue.
  • Factors affecting social interaction:
    • changes in physical appearance;
    • changes in motor skills;
    • medication induced mood changes; and
    • changes in appetite, toileting, etc.
  • Factors affecting learning:
    • neuropsychological effects of treatments and medications;
    • changes in fine motor skills;
    • changes in vision and/or hearing;
    • limitations on physical activity;
    • fatigue;
    • headaches; and
    • nausea.
  • Factors affecting medical care:
    • medication to be administered at school;
    • medications to be avoided;
    • exposure to infectious diseases; and
    • availability of school nurse to provide emergency care and troubleshoot.
  • Who to contact in case of emergency.
Q: What can the pediatrician expect from the school lunch program if a child needs a special diet? And what paperwork needs to be completed for this?

A: USDA regulations (7 CFR Part 15b) require substitutions or modifications in school meals for children whose disabilities restrict their diets. Another way you can help your patient is to provide a signed statement clearly defining:
  • the child's disability;
  • an explanation of why the disability restricts the child's diet;
  • the major life activity/activities affected by the disability; and
  • the food(s) to be omitted from the child's diet, and food or choice of foods that must be substituted.

Food allergies that may result in severe, life-threatening (anaphylactic) reactions meet the definition for "disability", and must also be accommodated, with your written statement. Check with the student’s school to determine the procedure for notifying the school of dietary modifications including food allergies.
For more information and a sample form see:

Accommodating Children with Special Dietary Needs in the School Nutrition Programs (PDF Document 849 KB)
From the U.S. Department of Agriculture Food and Nutrition Service, this document provides information about modifying school meals for students with disabilities and other dietary requirements including food allergies. The document includes a sample Eating and Feeding Evaluation form (Figure 1, page 34) to be completed by the child's parent and physician and a sample Information Card (Figure 2, page 35) for use by school food service staff in preparing meals for the child.

School Nurse Role

Q: What are the roles and responsibilities of school nurses?

A: One role of the school nurse is to bridge the gap between the worlds of medicine/health care and education. Because of the nurse's license and educational background, he/she is the only member of the school team to adequately address the health needs and procedures that must be carried out in the school setting.
Q: Who is involved in the development of the Health Plan?

A: Depending on the child's specific needs, if there is a Health Plan that does not involve multiple specialties, the school nurse may complete it and provide instruction to teachers and school staff. If the student is determined eligible for special education, a multi-disciplinary approach is needed where an IEP team will include the school nurse in planning the student's academic/health needs. The school nurse should write the Individualized Health Plan (care plan) for the student. Check with your state school nurse association, state education agency, or school district to find the nurse for the student's school.
Q: What can the school nurse be asked/expected to do? And what are his/her limitations?

A: The state Nurse Practice Act will provide information about limitations. School nurses should complete care plans on students who have a medical need, which may be as simple as a child taking medication for ADHD while at school or more complicated. School nurses should also be included in the IEP process.

With the health needs in mind, nurses cannot be told what they can delegate to another person (including unlicensed assisting personnel). The nurse has the legal license to determine what may be delegated and to whom it may be delegated. While the nurse may delegate the act to another person, the nurse still retains the responsibility and accountability for it.

Nurses may assess, but not diagnose. Generally, state Nurse Practice Acts allows the nurse to assess the medical situation and perform or delegate a specific procedure that will be done in the school. The nurse can give advice on incorporating the health needs of a student. For more information about your state Nurse Practice Act, see: National Council of State Boards of Nursing, or Nurse Practice Acts.


Information & Support

For Professionals

Medical Home to School Summary Form (PDF Document 40 KB)
Sample form to facilitate communication between health care providers and school professionals relating to health concerns that impact a student's education.

Utah School Nurse Association
Provides lists of school nurses by district, conference information, newsletters, and links to related sites for teachers and school nurses.

National Association of School Nurses
Professional association that provides information to school nurses including links to local affiliate organizations in each state.

National Council of State Boards of Nursing
The NCSBN Nurse Practice Act Toolkit, with access to each state's Nurse Practice Act and related information.

For Parents and Patients

Information Release Form (Utah Schools) (PDF Document 51 KB)
Sample form for schools that authorizes the exchange of information between the student’s health care provider and school professionals as it relates to the diagnosis/condition listed.

Utah Parent Center
A non-profit organization that provides training, information, referral, and assistance to parents of children and youth with all disabilities including physical, mental, hearing, vision, learning, behavioral, and emotional. Staff consists primarily of parents of children and youth with disabilities.

Center for Parent Information and Resources (DOE)
A large resource library related to children with disabilities. Parent Centers in every state provide training to parents of children with disabilities. Lists local conferences, support groups, advocacy tips, and suggestions for finding schools and other local services; Department of Education, Office of Special Education.


Authors: Janet Gibbs - 11/2008
Christine Timothy - 11/2008
Barbara Ward, RN BS - 11/2008
Contributing Author: Alfred Romeo, RN, PhD - 10/2008
Content Last Updated: 11/2008


This section was developed in collaboration with the Utah State Office of Education, Special Education and Utah Family Voices. The goal is to assist families in the process of caring for their children with disabilities by providing information about the most common issues and questions parents confront. The other pages of this section will help you locate more information about resources for you and your child.