On This Page
- Provider Tools: referral forms, care plans, guidelines and consultation
- Family Tools: Care notebook, emergency plans, information resource
- Resource Lists: County-specific lists, Key contacts, Care coordinators, Camp and Resource guides
- Transition to adulthood
This list highlights some of the major tools available to help health care providers and families provide family-centered, coordinated primary care for children and youth with special needs.
These tools, primarily developed or adapted for use in Washington State, are described in more details in other parts of this or linked websites. They are provided here for quick access.
NOTE: Many of these resources were developed or adapted by organizations funded by the Washington State Department of Health Children with Special Health Care Needs. The Washington State Medical Home Leadership Network and Washington State Medical Home Website, the Adolescent Health Transition Project, the Center for Children with Special Needs have all developed tools to support medical home partnerships that are linked to below.
Referral Form for Early Intervention
- Early Intervention Referral Form for Providers in Washington State- Birth to Age 3
Sample Early Intervention Referral from physicians’ offices can use with the Lead Family Resources Coordinators in their county (talk with Lead FRC before using). Consent for use or disclosure of health information between healthcare providers and early intervention.
- Universal Referral Form
created jointly by the AAP and the Training, Referral and Assessment Center for Excellence (TRACE). Includes release of information from parents for provider to share with EI program and checkbox for information you would like returned to you from the EI program.
- Medical Care Plans
Dr. Jack Stephens’ Chronic Care Management Forms
- Family-Initiated Care Planning Forms – Center for Children with Special Needs
Other Care plans: helps everyone interacting with the child to understand basic information about the child
Getting to Know Me (2 pg family-completed form introduing child)
What’s the Plan – Versions A and B (One page worksheet to organize questions and concerns)
- Emergency Care Plans
To facilitate prompt and appropriate emergency care for children with special health care needs, the American Academy of Pediatrics (AAP) and the American College of Emergency Physicians (ACEP) have developed an Emergency Information Form which can be used as a tool to transfer critical information about these children. Link to blank form, interactive form, sample form, parent information, policy statements and more.
Emergency Care Plans and additional tips from the Center for Children with Special Needs, at Seattle Children’s.
- MEDCON is a toll-free consultation and referral service of the University of Washington (UW) School of Medicine and its academic medical centers, Seattle Children’s Hospital, Harborview Medical Center and UW Medical Center. As a major resource for education, medical discovery and patient care, UW School of Medicine places particular importance on its communication with practicing physicians. The line is open 24 hours a day, seven days a week. A Medcon consultation coordinator will connect you with the appropriate expert.Call toll free 800.326.5300 (Seattle area: 206-543-5300) or email firstname.lastname@example.org
Diagnoses-Specific Care Guidelines and Patient Education Materials
- Emergency Care Plan for Children with Special Health Care Needs
From the American Academy of Pediatrics
- Blank Emergency Information Form
- Sample Emergency Information Form
- Emergency Preparedness Instructions for Parents (how to use the form)
Website directs patients/families to information to help answer health questions. MedlinePlus brings together authoritative information from the National Libraries of Medicine, the National Institutes of Health (NIH), and other government agencies and health-related organizations. Preformulated MEDLINE searches are included and give easy access to medical journal articles.Also: extensive information about drugs, an illustrated medical encyclopedia, interactive patient tutorials, and latest health news. In English and Spanish.
- County-Specific Resources for Children with Special Health Care Needs and Their Families in Washington
- List of Quick Key Contacts
Key organizations or people who know about resources in each community and can help you quickly find and access needed resources for children with special health care needs and their families (Family Health Hotline, CSHCN public health nurse coordinator, Birth to three early intervention family resources coordinator, parent support)
- Guide to Care Coordinators in Washington State
- Summer Camp Directory for Children with Special Needs- Washington
- Starting Point Resource Guide
Resources for Children with Special Health Care Needs in Washington State
- Adolescent Health Skills Checklists
- Adolescent Health History Forms
- Transition Timelines for Children and Adolescents with Special Needs
Transition Timelines are available for Chronic Illness/Physical Disability and for Developmental Disabilities. They put suggested activities on a visual timeline in age or developmental order.