I have an open communication policy. Email is the preferred line of communication that may then lead to phone conversations or meetings as deemed necessary and scheduled in advance. Email is helpful in keeping a communication trail and may be referred back to as needed.
Forms to be reviewed and digitally signed are $10 per signature.
Consent for assessment
Referral for school-based services which may occur annually or every 90 days
Behavioral Intervention (BI)
Habilitative Services (Hab)
Personal Care Services (PCS)
EPSDT
Speech services
Occupational therapy
Physical therapy
DME order forms for students with special equipment needs at school is $25 per form with review and consideration of the students individual need and how access to DME will help positively impact their time at school.
Individualized consulting on a case-by-case basis for medical perspective or support may be discussed. Price of service varies based on time required and complexity.
Individual student PCS assessments, allocation tools, and PCS care plans may be completed by Malia. Education/training may be simultaneously provided to the school nurse, if desired. Price of service varies based on time required and complexity.
Interview and input will be taken from parent(s)/guardians, school nurse, outside medical provider (as needed), SPED teacher, and/or para’s, file and record review, and student observation.
Medicaid forms (assessment and allocation) will be filled out appropriately to state standard and an individualized care plan will be created.
Initial and any follow-up training will be provided to the school nurse.
The school nurse will in turn review the care plan with parent/guardian and signatures will be obtained.
Once signed, care plan is received, an SDR (billing sheet) will be created and sent to the school nurse who will review the form with the SPED teacher and para’s or health technicians.
Invoice for services will be sent at the beginning of each month and prompt reimbursement is appreciated.
Through individual school processes students who have or may have conditions that impede academic participation or achievement are identified. Proper documents are signed (by parent or legal guardian) and gathered by designated school members and compiled with the “Medical Provider Recommendation/Referral for School Based Evaluations and Assessments” form.
Forms are attached as one document for Malia to review and sign. You may expect this to be completed within a timely manner.
Document check-list:
Physician referral/authorization form, filled out
Consent for exchange of information (or release of information, i.e. ROI) to be signed by parents/guardians for consent for me to obtain their records for review (since I am not their primary care provider)
Consent for Assessment signed by parents/guardians
Through individual school processes, student IEP documentation is completed and paired with the “Medical Provider Recommendation/Referral for School Based IEP Services” form. This form should indicate whether the referral is valid for 90-days or 365-days per Medicaid guidelines. Therapies that will always be 90-day include speech therapy, occupational therapy, and physical therapy. If the school is marking "long-term condition", there does not need to be additional documentation supplied. If asking Malia to check "long-term condition", please provide a copy of documentation in addition to the check-list below. Additional documentation will need to include the provider's name who gave the long-term diagnosis and the diagnosis itself. This may be a page from an eligibility report that is sometimes included on the first page of the IEP.
Forms are attached as one document for Malia to review and sign. You may expect this to be completed within a timely manner.
Document check-list:
Physician referral/authorization form, filled out
ICD-10 code required for long-term conditions
Consent for exchange of information (or release of information, i.e. ROI) to be signed by parents/guardians for consent for me to obtain their records for review (since I am not their PCP)
Consent for assessment signed by parents/guardians
First page of the student's IEP and service grid
Optional Statement of Service Delivery
Intellectual disabilities
F79 Unspecified intellectual disabilities
Mental deficiency NOS
Mental subnormality NOS
Other developmental disorders of speech and language
F80.9 Developmental disorder of speech and language, unspecified
Other developmental disorders of scholastic skills
F81.9 Developmental disorder of scholastic skills, unspecified
Learning disability NOS
Learning disorder NOS
Knowledge acquisition disability NOS
“Developmental delay”
F82 Specific developmental disorder of motor function
Clumsy child syndrome
Developmental coordination disorder
Developmental dyspraxia
“Multiple disabilities”
Pervasive developmental disorders
F84.0 Autistic disorder
F84.9 Pervasive developmental disorder, unspecified (atypical autism)
“PDD NOS”
Disorders of psychological development (developmental delay)
F88 Other disorders of psychological development
Developmental agnosia
Global developmental delay
Other specified neurodevelopmental disorder
F89 Unspecified disorder of psychological development
Developmental disorder NOS
Neurodevelopmental disorder NOS
F90 Attention-deficit hyperactivity disorders
F95 Tic disorder
F95.2 Tourette’s disorder
Other behavioral and emotional disorders with onset usually occurring in childhood and adolescence
F98.9 Unspecified behavioral and emotional disorders with onset usually occurring in childhood and adolescence (emotional disturbance)
S06 Intracranial injury
S06.0 Concussion
S06.9 Unspecified intracranial injury (includes traumatic brain injury)
G80 Cerebral palsy
G80.9 Cerebral palsy, unspecified
H54 Blindness and low vision
H54.7 Unspecified visual loss
H54.8 Legal blindness, as defined in USA
H91 Other and unspecified hearing loss
H91.9 Unspecified hearing loss
Q90 Down syndrome
Q90.9 Down syndrome, unspecified
R62 Lack of expected normal physiological development in childhood and adults
R62.5 Other and unspecified lack of expected normal physiological development in childhood
Other health impairment
F34 Persistent mood [affective] disorders
F34.9 Persistent mood [affective] disorder, unspecified