Pediatric Primary Care

Development and Behavior

Referrals

August 2023 update:

As of August 2023, we will begin to use Staff Messages with SmartPhrases to convey requests for

Speech, OT, PT
ABA
Early Start
DBP visits with Dr. Buysse
Social Work consults

Please use the Referral SmartPhrase table below for guidelines

Referral SmartPhrases

Isolated speech delay - kids not yet in school

IEP, Educational Support

ADHD

General Resources

GPCHC Clinical Pathway
ADHD Encounter Form
Information for families (Plain Language Pediatrics - bilingual)
Suggested cardiac screening before starting ADHD medication

Medication management

ADHD Medication Table

Visual medication guide

Vanderbilt Scales

Parent initial screen (bilingual, Spanish first)
Teacher form with return instructions (English only)
Parent follow up (bilingual, Spanish first)
Teacher follow up
Teacher request/return cover letter
Scoring instructions

Adult ADHD Symptom Checlist

Scoring information

Autism

Miscelleaneous referral information

GGRC Early Start - scroll to third-party Early Start Referral link
Early Start contact information for families
Early Start outreach materials
HPSM Care Coordination referral form
Authorization for communication
Parent handout on IEP process
Sample letter to support 504 plan
504 Accommodations guide (example) - with suggested accommodations by condition

SSI, IHSS

Quick Links

Vanderbilt scoring

MCHAT-R scoring

ASQ Intervention Activities

Surrey Place language resources

Authorization for Communication form

Instructions - GPCHC DBP referral