Prior Written Notice Of District'S Proposal/refusal No Ot Prescription Form

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PRIOR WRITTEN NOTICE OF DISTRICT’S PROPOSAL/REFUSAL

NO OT Prescription

Hancock County Schools

Student’s Full Name: ____________________________________________________

Date: ________________________

School: _______________________________________________________________

DOB: _________________________

Parent(s)/Guardian(s): __________________________________________________

Grade: _______________________

Address: _____________________________________________________________

WVEIS #: ____________________

City/State: ___________________________________________________________

Telephone: __________________

Dear ______________________________________,

As a result of:

___ a Student Assistance Team (SAT) meeting conducted on ____________________,

___ an Eligibility Committee (EC) meeting conducted on ________________________,

___ an Individualized Education Program (IEP) Team meeting conducted on ______________________,

___ a disciplinary action occurring on _____________________________,

_X_ other failure to provide a prescription from a medical doctor for Occupational Therapy Services.

the district is providing you with written notice of the district’s ___proposal / _X_ refusal of the following action(s) with regard to:

___ the educational evaluation or reevaluation of the student.

___ the identification of the student as having a disability.

___ the educational services and/or placement of the student.

___ the provision of a free appropriate public education (FAPE) to the student.

_X_ other provide occupational therapy services as indicated by the IEP.

Specifically, the district is proposing discharging the student from Occupational Therapy Service.

The district is proposing or refusing this action because: as you are aware state law requires a prescription to be recived prior to

beginning/continuing occupational therapy services.

The evaluation procedure(s), assessment(s), record(s) or report(s) the district used as a basis for the ___ proposed/ _X_ refused

action are: the student is eligible for these services based on assessment and IEP. However, since the prescription was not returned

services cannot be provided.

Other options considered include: None Noted.

The reasons the above options were rejected are: Statement at IEP meeting regarding the need for a prescription was maed along

with a reminder letter sent home. Prescription still has not been received, therefore OT can not be provided even though your child

is eligible and has been determined to need these services..

Other factors relevant to the district’s _X_ proposal / ___ refusal are: _Your child will continue to receive OT services if the

prescription is received within ten days or by September XX, 20XX. If not services will be discontinued through and addendum to the

IEP..

Exceptional students and their parents have protections under the procedural safeguards. A copy of the Procedural Safeguards Brochure and assistance in

understanding the provisions of the procedural safeguards may be obtained by contacting the Director of Special Education at 304-564-3411, as appropriate, the local

Parent Educator Resource Center at __________________ and/or the West Virginia Department of Education, Office of Special Programs at 304-558-2696 or 1-800-

642-8541.

Sincerely,

__________________________________________

Signature/Position

Date

West Virginia Department of Education

July 2013