Ohio Section 504 Referral for Assistance Form Instructions and User Guide PowerSchool IEPPLUS
Released Month April, 2017 Document Owner: IEPPLUS This edition applies to Release 4.3 of the IEPPLUS software and to all subsequent releases and modifications until otherwise indicated in new editions or updates. The data and names used to illustrate the reports and screen images may include names of individuals, companies, brands, and products. All of the data and names are fictitious; any similarities to actual names are entirely coincidental. PowerSchool is a trademark, in the U.S. and/or other countries, of PowerSchool Group, LLC or its affiliate(s). Copyright 2001-2017 PowerSchool Group LLC and/or its affiliate(s). All rights reserved. All trademarks are either owned or licensed by PowerSchool Group LLC and/or its affiliates.
TABLE OF CONTENTS OVERVIEW... 4 FORM INSTRUCTIONS... 4 FORM CREATION... 4 Step 1 Select a Student... 4 STEP 2 Create Form... 4 SELECT OR CREATE A REFERRAL... 6 Form Navigation/Tool Bar... 6 SETUP AND CONFIGURATION... 8 CODE TABLE SETUP... 8 SECTION 504 - REFERRAL FOR ASSISTANCE FORM: DATA MAPPING... 9 OH REFERRAL FOR 504 ASSISTANCE FORM... 9 OH: SECTION 504 - REFERRAL FOR ASSISTANCE MAPPING... 11 SECURITY... 12 Form Printout...13 VALIDATION RULES... 13 Revisions...16 Contents 3
OVERVIEW A student is entitled to a Section 504 Accommodation Plan if they have been identified and the evaluation shows that the individual has a mental or physical impairment that substantially limits one or more major life activities. This determination is made by a team of knowledgeable individuals, including the parents, who are familiar with the student and his/her disability. The form describes various district concerns for this student and indicates whether the district will continue with the referral process to gather evaluations to determine if the student needs additional assistance. This form also creates the referral record and stores information in IEPPLUS for reporting purposes. FORM INSTRUCTIONS FORM CREATION The form creation process includes two steps: 1. Select a student 2. Create or Select a Referral STEP 1 SELECT A STUDENT 1. Click Student Management > Manage an Existing Student. 2. Use the Search window to find the student based on either, Last Name, First Name or Student ID. 3. Click Search. Then click the appropriate Name to select a student. 4. Once a student has been selected, the student s name, ID, birth date, and age will display. STEP 2 CREATE FORM The available Section 504 Forms that can be created for a student will be listed in the student tool bar located on the left side of the screen. Click on the 504 Referral for Assistance link: The 504 Referral for Assistance Summary screen will display, listing any prior forms created for the student. The most recent form will display at the top of the list. To review an existing form, click the appropriate link. To create a new form, click the New icon. Overview 4
Form Instructions 5
SELECT OR CREATE A REFERRAL 1. If a Referral record has already been created, then choose it from the drop-down. 2. If one does not exist, then click the radio button to the left of this option and enter a Referral Date, and select a Referral Type from the drop-down. The form will create the referral record and the Referral for Assistance Form at the same time. Note: The Referral type must have an Alternate Code = 504IR. 3. Select a Letterhead (optional). 4. When done, click the Create Form link. The user also has the option to click Cancel as well to clear the form. If this is chosen, then the form wizard will return the user back to the 504 Referral for Evaluation Summary screen. FORM NAVIGATION/TOOL BAR Once the form has been created, it will display the cover page. A tool bar will display on the left side of the screen, divided into the following areas: 1. Sections There is a separate link for each section of the form. Click on any link to move to that section. 2. Maintenance These options will maintain Form Information, such as Form Name, Date Ranges, Letterhead, etc. Form Information also provides the ability to change the form Start/End dates and to reset the dates of services, placements, courses and goals. Refresh and Delete functionality is available depending on user security. 3. Validation These options will maintain the following items: Ready For Review, Lock/Unlock, and Finalize. Form Instructions 6
4. File Attachments Click the plus icon (+) to add an attachment. Click the minus icon to delete an attachment. 5. Archives Archives are permanent PDF copies of the form. Click Finalize in the Validation section to create an Archived copy. The form should be finalized and archived only after it has been fully completed and a copy has been sent home to the student s parents or guardians. Archives will display the form Meeting Date or Form Start Date (if no meeting exists) and the actual date and time the record was created when hovering over the PDF icon. Archives will display in descending order by date created. *Note: Archives may only display the date created and not the meeting/form date, depending on district settings maintained under Options > Set System Options > Form: The following options will display at the top of the form (see screenshot below). Save Information from each section should be saved before moving to another section. Return Click the Return icon to return to the Form Summary screen. Print Preview Print Preview will display the form in Adobe Acrobat. Mouse over the bottom of the form preview to see the toolbar illustrated below. Select the Print icon or click the Save icon to save a copy of the form to your computer. The plus (+) icon will enlarge the preview for ease of viewing. Form Instructions 7
SETUP AND CONFIGURATION CODE TABLE SETUP Navigate to Maintenance > Manage Code Tables. Select the name of the table from the drop down list (ex: Referral ): To add a code: choose New from the top menu. Enter the Code in the yellow box, and then click on Update. Remember to Save the record when finished: To add or edit an Alternate Code, first click Show Alternate Codes at the top of the page. Then click Edit on the applicable Code record to open the record for changes. An example is shown below: Setup and Configuration 8
Note: This form uses Referral records with the Referral Code, Alternate Code = 504IR or 504RE Once the record is open, click the appropriate link to add a new Alt Code or Edit an existing one. Clicking delete will remove an existing Alternate Code. When finished with the changes, click the Save icon. SECTION 504 - REFERRAL FOR ASSISTANCE FORM: DATA MAPPING This section provides data source and destination information, where applicable, for all fields on the form. If source or destination data is missing or incorrect, follow the navigation indicated in this section to add or correct the data. Also included is a description of necessary Alternate Codes, if required. To add, edit or lookup a code, navigate to Maintenance > Manage Code Tables. Select the name of the table from the drop down list. Then click the Show Alternate Codes link at the top of the screen to see the applicable codes (see section on Code Table Setup for more information). OH REFERRAL FOR 504 ASSISTANCE FORM Logo 1 SunGard School District 123 Main Street, Line 2 Anytown, IL 12345 Phone Number 2 SECTION 504 - REFERRAL FOR ASSISTANCE 3 5 8 9 10 Student Name: Date of Birth: School: Grade: Date of Referral: Parent Name(s) Address: Communications: 6 4 7 11 A. Statement of Suspected Section 504 Disability: Please complete this form is you suspect that this student may have a physical or mental impairment that substantially limits one or more major life activities. (See below). 12 B. Nature of Concern: 13 1. Check suspected physical /mental impairment and attach data sources supporting the diagnosis. Section 504 - Referral for Assistance Form: Data Mapping 9
[ ] Asthma [ ] Dyslexia [ ] Multiple Sclerosis [ ] Attention Disorder/ADHD [ ] Emergent Allergy [ ] Muscular Dystrophy [ ] Brain Injury [ ] Emotional Illness [ ] Orthopedic Impairment [ ] Cancer [ ] Epilepsy [ ] Recovering Chemically Dependent [ ] Cerebral Palsy [ ] Heart Disease [ ] Seizures [ ] Developmental Aphasia [ ] Hearing [ ] Speech Impairment [ ] Diabetes [ ] Minimal Brain Dysfunction [ ] Visual Impairment [ ] Other: 14 2. Check any major life activity(ies) that are substantially limited. (This list is not exhaustive) [ ] Bending [ ] Reading [ ] Breathing [ ] Seeing [ ] Caring for one s self [ ] Sleeping [ ] Communicating [ ] Speaking [ ] Concentrating [ ] Standing [ ] Eating [ ] Thinking [ ] Hearing [ ] Walking [ ] Learning [ ] Working [ ] Lifting [ ] Other: [ ] Performing manual tasks 15 3. Check any major bodily functions are limited. (This list is not exhaustive) [ ] Bladder [ ] Respiratory System [ ] Bowel [ ] Reproduction [ ] Brain [ ] Immune System [ ] Circulatory/Cardiovascular System [ ] Neurological System [ ] Digestive System [ ] Normal Cell Growth [ ] Endocrine System [ ] Other: 16 4. Indicate how the any major life activity(ies) and/or major bodily function(s) (is)(are) substantially limited. 17 C. To date, what accommodations / modifications / interventions or special provisions have been made to assist the student? Section 504 - Referral for Assistance Form: Data Mapping 10
18 Signature of Person Making Referral Relationship to Student Date THE SIGNATURE OF THE PRINCIPAL RECEIVING THIS REFERRAL DOCUMENTS THAT A COPY OF THIS FORM AND THE NOTICE OF SECTION 504/ADA PROCEDURAL INFORMATION AND RIGHTS HAVE BEEN GIVEN OR SENT OT THE PARENT/GUARDIAN OF THE STUDENT. 19 Principal s Signature Date Received OH: SECTION 504 - REFERRAL FOR ASSISTANCE MAPPING IEPPLUS Ohio Section 504 - Referral for Assistance 1 Client Logo 2 Letterhead: Maintenance, Manage Letterhead and/or User Defaults 3 Student Name Student, Demographics Name: First, Middle, Last, Qualifier 4 Date of Birth Student, Demographics, DOB 5 School Student, Enrollment Location, as of Form Date 6 Grade Student, Enrollment, Grade, as of Form Date 7 Date of Referral Referral Date linked to the form 8 Parent(s) Contact Type = Parent/Guardian, and/or Surrogate Parent First, Middle, Last Names & Qualifier (ie John H. Jones Jr.) - Display all names 9 Parent Address Contact Type = Parent/Guardian, and/or Surrogate Parent - Associated Home address - 10 Communications Basic Information, Contact, Contact Type = Parent / Guardian, and/or Surrogate Parent - List all communications in the Contact record on a single line separated by commas. 11 A. Statement of Text Box Suspected Disability 12 B. Nature of Concern Text Box 13au Impairment 1.Suspected 14 2.Limited major life activity 15 3.Limited body functions 16 4.How substantially limited Check Boxes (20) + Other Text box Check Boxes (18) + Other Text box Check Boxes (11) = Other Text box Text Box Section 504 - Referral for Assistance Form: Data Mapping 11
17 C. Accommodations Text Box 18a 504 Referral Signature Changed to match SE Referral for Evaluation form controls. - Staff Lookup, saves to form answer. - Staff Position lookup, saves to form answer. 18b Relationship to Student Text Box - Fill from Staff position lookup. 18c Date Autofill today s date, allow user to change or remove. 19 Principal Signature Staff selection drop down - Text box for manual name - Print under signature line SECURITY User or group level security permissions will control access and functionality based on least restrictive settings (group or user level security). In other words, a user assigned to a group (or groups) will have both user and group level permissions, and the least restrictive settings will take precedence. Since all users are assigned to the SPIPUBLIC group, it is best practice to uncheck all permissions for this group, as well as all permissions at the user level. This will ensure the group level permissions are the least restrictive. Administrators would have all permissions by default. To view or maintain security permissions for an existing user or group, navigate as follows: Security > Manage Groups or Manage Users. Select the group or user and click on the Permissions tab. Scroll down to the section illustrated below and select the applicable check boxes. The permissions check boxes will control access and functionality as follows. Permission Checked On Links providing access to existing forms (or archives) active. User will have the View ability to access existing forms (or archives) but cannot change any data. User will have the ability to create new Add forms. Entire form User will have the ability to edit any field in the entire form. Section User can only edit fields in the Edit specified sections. If granting the ability to edit the entire form, ALL the section permissions must be checked on. Not Checked On Links providing access to the form inactive. User will not have the ability to view the form. User will not have the icon to create a new form. Entire form All fields read only. Section Fields within section read only. Security 12
Permission Checked On Not Checked On User will have active Delete link in the Delete form tool bar providing the ability to delete a form. User will have active Lock link in the form Lock tool bar providing the ability to lock a form. User will have active Unlock link in the Unlock form tool bar providing the ability to lock a form. User will have active Finalize link in the Finalize form tool bar providing the ability to finalize and create an archive copy of a form. Revise Not applicable for this form. Not applicable for this form. User will have active Refresh link in the Refresh form tool bar providing the ability to update a form with all the latest information. Reset Dates Not applicable for this form. Delete link in form tool bar inactive. User will not have the ability to delete a form. Lock link in the form tool bar inactive. User will not have the ability to lock a form. Unlock link in the form tool bar inactive. User will not have the ability to unlock a form. Finalize link in the form tool bar inactive. User will not have the ability to finalize and create an archive copy of a form. Refresh link in form tool bar inactive. User will not have the ability to refresh a form. Not applicable for this form. FORM PRINTOUT All form reports are printed from the Form Toolbar, Print Preview. VALIDATION RULES Section Description Error Message (48) Main Date of Referral is required. Date of Referral is missing. Error Description (1024) Date of Referral is missing. Most likely a referral has not been attached to the form. Warning / Error Mapping ID(s) Failure Condition(s) Error 7 Most likely a Referral has not been attached to the Form. Since the Creation Wizard requires that a Referral be Exception Case(s) N/A Validation Rules 13
attached before the Form can be created, this rule will never fail. Main Main Main Main Statement of Suspected Disability is required. Nature of Concern is required. School is required. Grade is required. Statement of Suspected Disability is missing. Nature of Concern is missing. Student School is missing. Student Grade is missing. The textbox for the Statement of Suspected Section 504 Disability is required but it is empty. The textbox for the Nature of Concern is required but it is empty. Student School is missing. Check the Student's Enrollment record for Enrollment Location. Student Grade is missing. Check the Student's Enrollment record for Enrollment Grade. Error 11 User has not filled in the textbox. Error 12 User has not filled in the textbox. 6 Student's Enrollment record is missing or out of date. If the record is there and current, the Enrollment Location is blank. 7 Student's Enrollment record is missing or out of date. If the record is there and current, the Enrollment Grade is blank. N/A N/A N/A N/A Validation Rules 14
OH Referral for 504 Assistance Q&A s FORM ID# (make same as IL forms for PDF streaming) Field QU_Area QU_Section QU_Subsection FAW_Order FAW_ FAW_Notes State 11 OH_504ReferralAsst SuspectedDisability Text 12 OH_504ReferralAsst NatureOfConcern Text 13a OH_504ReferralAsst SuspectedImpairment Asthma X 13b OH_504ReferralAsst SuspectedImpairment ADHD X 13c OH_504ReferralAsst SuspectedImpairment BrainInjury X 13d OH_504ReferralAsst SuspectedImpairment Cancer X 13e OH_504ReferralAsst SuspectedImpairment CerebralPalsy X 13f OH_504ReferralAsst SuspectedImpairment Aphasia X 13g OH_504ReferralAsst SuspectedImpairment Diabetes X 13h OH_504ReferralAsst SuspectedImpairment Dyslexia X 13i OH_504ReferralAsst SuspectedImpairment Allergy X 13j OH_504ReferralAsst SuspectedImpairment EmotionalIllness X 13k OH_504ReferralAsst SuspectedImpairment Epilepsy X 13l OH_504ReferralAsst SuspectedImpairment HeartDisease X 13m OH_504ReferralAsst SuspectedImpairment MinBrainDys X 13n OH_504ReferralAsst SuspectedImpairment MultipleSclerisis X 13o OH_504ReferralAsst SuspectedImpairment MuscularDystrophy X 13p OH_504ReferralAsst SuspectedImpairment OrthoImpairment X 13q OH_504ReferralAsst SuspectedImpairment ChemicallyDependent X 13r OH_504ReferralAsst SuspectedImpairment Seizures X 13s OH_504ReferralAsst SuspectedImpairment SpeechImpairment X 13t OH_504ReferralAsst SuspectedImpairment VisualImpairment X 13u OH_504ReferralAsst SuspectedImpairment Other X Text 14a OH_504ReferralAsst LifeActivities Bending X 14b OH_504ReferralAsst LifeActivities Breathing X 14c OH_504ReferralAsst LifeActivities SelfCare X 14d OH_504ReferralAsst LifeActivities Communicating X 14e OH_504ReferralAsst LifeActivities Concentrating X 14f OH_504ReferralAsst LifeActivities Eating X 14g OH_504ReferralAsst LifeActivities Hearing X 14h OH_504ReferralAsst LifeActivities Learning X 14i OH_504ReferralAsst LifeActivities Lifting X 14j OH_504ReferralAsst LifeActivities ManualTasks X 14k OH_504ReferralAsst LifeActivities Reading X 14l OH_504ReferralAsst LifeActivities Seeing X 14m OH_504ReferralAsst LifeActivities Sleeping X 14n OH_504ReferralAsst LifeActivities Speaking X 14o OH_504ReferralAsst LifeActivities Standing X 14p OH_504ReferralAsst LifeActivities Thinking X 14q OH_504ReferralAsst LifeActivities Walking X 14r OH_504ReferralAsst LifeActivities Working X 14s OH_504ReferralAsst LifeActivities Other X Text 15a OH_504ReferralAsst BodilyFunctions Bladder X 15b OH_504ReferralAsst BodilyFunctions Bowel X 15c OH_504ReferralAsst BodilyFunctions Brain X 15d OH_504ReferralAsst BodilyFunctions Circulatory X 15e OH_504ReferralAsst BodilyFunctions Digestive X 15f OH_504ReferralAsst BodilyFunctions Endocrine X 15g OH_504ReferralAsst BodilyFunctions Respiratory X 15h OH_504ReferralAsst BodilyFunctions Immune X Validation Rules 15
15i OH_504ReferralAsst BodilyFunctions Neurological X 15j OH_504ReferralAsst BodilyFunctions CellGrowth X 15m OH_504ReferralAsst BodilyFunctions Other X Text 16 OH_504ReferralAsst SubstantiallyLimited Text 17 OH_504ReferralAsst Special Provisions Text 18a,b OH_504ReferralAsst RelationshipStudent Text Text 18c OH_504ReferralAsst RelationshipStudentDate Date 19a.b OH_504ReferralAsst PrincipalName Text Date 20a OH_504ReferralAsst OfficialUse CaseManager X 20b OH_504ReferralAsst OfficialUse Parents X 20c OH_504ReferralAsst OfficialUse Principal X 20d OH_504ReferralAsst OfficialUse File X 20e OH_504ReferralAsst OfficialUse Other X Text REVISIONS 4/25/17: Removed Official Use Only field from the mapping document (was #20) 9/21/15: Creation of new form. Validation Rules 16