Home Hospital Instruction
To qualify for the program, the student’s disability must be diagnosed and documented in writing on our Physician/Medical Referral Form by a licensed medical doctor (M.D) only. All other medical personnel signatures will not be accepted. The disability must be temporary- the result of an accident, physical illness or a specific placement defined in a student’s Individualized Education Program (IEP) based on a medical issue.
The Physician/Medical Referral Form must indicate the length of service with a minimum 15 school day duration up to a maximum of 90 school days and shall expire at the end of each School Year or sooner.
A diagnosis involving a temporary mental or emotional illness requires that a Mental Health Referral Form must be done by the treating Psychiatrist and, in addition to the diagnosis, the request must also include, but not limited to:
· A therapeutic treatment plan
· A statement regarding how being on Home Hospital will benefit the overall treatment of the student rather than making adjustments in the school program.
· An educational goal
· Time frame limited to a minimum of 45 school days
Students with a Mental Health Referral Form will be considered for placement at our Independent Study School, 21st Century Learning Institute.
Home and Hospital Services will not be provided to special education students until an IEP meeting is held indicating the need for a change in placement/service delivery to the Home Hospital program. The student's Administrator or Administrator designee at his/her home school site will initiate and complete this process and forward the updated IEP to the Student Services Department. The hour and number of days of instruction offered to Special Education students will be determined by the Change of Placement IEP to be held at the time the student is placed on home and hospital instruction and can be anywhere from 1 to 5 hours a week.
When it is determined the student is able to return to the school site, an IEP shall be held at the home/resident school stating the change in placement/ services back to his/her home resident school.
Complete this online application for Home Hospital for the 2021-22 School Year
After you submit the online application, you will receive the form back via email, prompting you to download the attached Physician/Medical referral or Mental Health Referral Form.
Once you print and download the form, you will take this referral form to your physician to fill out and sign, or if your student has a mental health condition you will receive the Mental Health referral form to take to your Psychiatrist or Psychologist to fill out and sign.
Once you have the appropriate signature on the referral form, you will open the online application and upload the form, then sign and submit. This referral form must be uploaded into the online application in order to be considered for placement.
After you submit, the Home Hospital team which may include, but not limited to Coordinators, School Nurses, and Counselors who will verify that changes in the school environment cannot be made to accommodate the student. The Physician or Psychiatrist may be called to verify the diagnosis and discuss alternative educational programs. The team will submit their findings and recommendations to the Coordinator of the Home Hospital Program. If the request is approved, arrangements will be made for services to be provided.