Referral+information+and+forms+for+CDC,+Regional+Center,+and+School+District


 * Where to refer if your concern is:**
 * **ADHD, Autism, or neurodevelopmental concerns**
 * The **CAAD** (Clinic for ASD & ADHD Diagnostics) performs Neurodevelopmental evaluations on toddlers through 18 years old who speak English. The evaluations are performed in Martinez by Dr. Maher, Catherine Audrey-Quinn OTR/L, and Dr. Gwen Hamilton. Patients may also be referred to the CAAD for complicated ADHD medication management by Dr. Hamilton.
 * To refer to the CAAD, please complete ccLink internal referral, specifying reason for referral, and fax to 925-370-5277. Please include up to date patient contact information (with working voice-mail). Voice-mail referrals will no longer be accepted as of 2/14/11. See below under **"**CCRMC Clinic for ASD & ADHD Diagnostics: Referrals for Neurodevelopmental Evaluations or ADHD Medication Management" for specifics.
 * **Speech Delay**
 * If under 3, child should be referred to the **Regional Center of the East Bay**
 * To refer, fill out form below, and call 510-618-6195.
 * RCEB form for children below age 3 - [[file:Early Start Interagency Referral Dec2014-community (2).doc]]
 * If age 3 or over, child should be referred to the local school district
 * **Learning disabilities**
 * School should do IEP (see below under "Process for school district evaluations")
 * If you suspect attention difficulties, you can refer to CDC for ADHD evaluation
 * **Reading disorder**
 * Refer to the local school district for full evaluation
 * **Suspension/school difficulties**
 * Refer to local school for behavioral assistance
 * **Mental Health**
 * From birth to age 5 (sometimes 6)
 * East County: Lynn Center at 925-439-9628
 * Central County: We Care Services for Children at 925-671-0777
 * West County: Early Child Mental Health Program at 510-412-9200 (sometimes sees over age 6 depending on referral)
 * If 6 or over
 * Mental Health Access Line at 888-678-7277
 * If patient has CCHP commercial, family should call CCHP Mental Health Authorizations, at 925-313-6683
 * **A chronic, severe neurodevelopmental condition in a child up to 18 years old.**
 * Regional Center may provide services for life if a child has any of the following:
 * Epilepsy/seizure disorder impacting every day life
 * Cerebral palsy impacting every day life (difficulty with ADLs, etc.)
 * Autism Spectrum Disorders
 * Intellectual Disability
 * Patient has condition(s) or needs services similar to a child with Intellectual Disability
 * To refer a child up to 18 years of age who has any of these conditions, fill out the form below and call the **Regional Center** at 510-618-6122.
 * RCEB form for children 3 years and older - [[file:ccrmc/RCEB 3YO referral form 2011.doc|RCEB 3YO referral form 2011.doc]]

> **(Phone & fax numbers may have changed please see website for current information)** > **[|http://www.cccoe.k12.ca.us/directory/]** > Antioch Unified School District 925.706.5343 > Brentwood Unified School District 925.513.6315 > Byron Union School District 925.634.6644 > Canyon Elementary School Dist. 925.376.4671 > **John Swett Unified School District (JSUSD)**: (Rodeo, Crockett and parts of Hercules) > __**Special Ed Evals 3-5 years old- call 510.787.3040**__ **__OR 5-22 years old – contact school of attendance__** > Knightsen School District 925.625.0073 > Lafayette School District 925.299.3510 > Martinez Unified School District: 925.313.0480 x 217 > Moraga (administered by WC) 925.944.6850 x 123 > Mt. Diablo Unified School District (MDUSD): 925.825.0144 (Bay Point, Concord, Pleasant Hill, & part of Walnut Creek) > Oakley Unified School District 925.625.7060 > Orinda Union School District 925 254.4901 x 6216 > Pittsburg Unified School District 925.473.4278 (doesn't include Bay Point) > San Ramon Valley Unified School Dis. 925.820.6815 > Walnut Creek School District 925.944.6850 x 123 > **West Contra Costa Unified School District (WCCUSD)** Birth to 5 - Cameron School 510.233.1955 -serving El Cerrito, Richmond, San Pablo, Pinole, El Sobrante and parts of Hercules):Ages 5 to 22 years old - contact school of attendance.
 * Accessing School District Resources:**
 * The family must request a Student StudyTeam meeting (SST) in writing to their district. This meeting is the first step towards an Individual Education Program (IEP).
 * If the family has had an SST, they can request that their child be evaluated in all areas, e.g. psychoeducational, speech and language evaluation, but it must be requested in writing.
 * Many families request an IEP, and some districts will honor that, but other districts formalize the process and start with an SST first.
 * __**School Districts**__

For more information on referring to the **Regional Center**, see Regional Center of the East Bay Referral Instructions 1/2011.


 * CCRMC Clinic for ASD & ADHD Diagnositcs: Referrals for Neurodevelopmental Evaluations or ADHD Medication Management**


 * __Referrals for Neurodevelopmental Evaluations:__**
 * **__For users of ccLink, please complete ASD & ADHD Diagnositics Internal Referral and mark boxes that apply for reason of referral.__**
 * For non ccLink users, all referrals must be written and faxed to 925-370-5277 or mailed to Maria Estrada, LVN and/or Krista Peterson, LCSW, CCRMC MSS Trailer 2500 Alhambra Avenue, Martinez, CA 94553. We are no longer able to accept voice mail referrals. Referrals that have inadequate information or are inappropriate will be returned. Please see new CAAD Referral form.
 * CAAD requires detailed information on reason for referral and type of evaluation requested for rule out ADHD and/or rule out Autistic Spectrum Disorder. Please provide current patient contact information and relevant diagnostic concerns.
 * Staff will attempt only once to contact the patient’s family by phone, so inform your patient’s family to provide a phone number that accepts voice mail and is a working number.
 * ONCE all required information is received from both the referring provider and the patient’s family/guardian, at that time most patients will be seen within four to six weeks.
 * If one CAAD evaluation appointment is missed, your remaining previously scheduled appointments will be cancelled. At least 24 hours cancellation notice is required.
 * Reminder calls are a courtesy and they are dependent on the Medical Social Service clerk’s availability. It is the patient family’s responsibility to know when the next appointment is scheduled. Initial appointment slips will be mailed.


 * __Referrals for ADHD Medication Management__**
 * **__For users of ccLink, please complete ASD & ADHD Diagnositics Internal Referral and mark boxes that apply for reason of referral.__**
 * For non ccLink users, all referrals must be written and faxed to 925-370-5277 or mailed to Maria Estrada, LVN and/or Krista Peterson, MSW, at CCRMC, MSS Trailer, 2500 Alhambra Avenue, Martinez, CA 94553. We are no longer able to accept voice mail referrals. Referrals that have inadequate information will be returned or denied.
 * CAAD requires detailed information on reason for referral. For medication consults with Dr. Hamilton, please list previous medication tried (if any) and reason for referral.
 * CAAD requires current patient contact information. Staff will attempt only once to contact the patient’s family by phone, so inform your patient’s family to provide a phone number that accepts voice mail and is a working number.
 * Reminder calls are a courtesy and are dependent on the Medical Social Service clerk’s availability. It is the patient family’s responsibility to know when the next appointment is scheduled.