Prior Written Notice. Washington IEPPLUS

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2 TABLE OF CONTENTS DATA MAPPING... 3 PRIOR WRITTEN NOTICE (FORM)... 3 EVALUATION/REEVALUATION CONSENT (REPORT)... 5 MEDICAID VERIFICATION ELIGIBILITY (REPORT)... 7 VALIDATION RULES: PRIOR WRITTEN NOTICE... 9 REVISION HISTORY: SunGard K-12 Education Copyright 2013 Page 2 of 10

DATA MAPPING PRIOR WRITTEN NOTICE (FORM) A 1 2 3 4 5 6 7 8

4 A Letterhead 1 Date 2 P/G Name & Address, Adult Student WA Prior Written Notice (Form) IEPPLUS: WA Prior Written Notice Letterhead, System or User & District Logo Date Control. Use Today s date, enable user to modify date. - Display date on PWN Form Summary screen Basic Information, Contacts, Type = Parent/Guardian or Surrogate Parent & Mail Address - Prints one letter to each P/G indicated as receiving mail. - Student letter for student s age 18 as of date of meeting. - Maintenance, Manage Code Tables, Release/Waiver, Check for Release/Waiver of type = Parental Rights Retained. If it exists in the proper time frame, student does not receive mail and does not participate in Educational Decisions. 3 Student Name Student, Demographic, First, Middle, Last name, Qualifier 4 Student ID Student, Demographic, Student ID 5 Date of Birth Student, Demographics, DOB 6 Purpose of Notice 7 Action Proposed/Refused 8 Why Actions Proposed/Refused 9 Evaluations Check boxes - Column 1 Choose One only - Column 2 Choose One Only - Column 3 enable multiple selection Other: Narrative text box Text box - Ability to select statements from SPS Default Goalbook - Category = PWN, Subcategory = Actions Proposed/Refused Text box - Ability to select statements from SPS Default Goalbook - Category = PWN, Subcategory = Why Proposed/Refused Text box - Ability to select statements from SPS Default Goalbook - Category = PWN, Subcategory = Evaluation Description - Display linked Form Evaluations/Test records 10 Other Relevant Factors Text box System or User Letterhead - Text Box o Auto-fill from Letterhead Line 1 = Contact Name 11 Procedure Safeguard Contact Line 2 = Position Line 3 = Telephone Number Maintenance, Manage Letterhead, Staff/type Enclosure = Procedure Safeguard Contact. Staff Grid: Ability to add staff member from staff table. Checkboxes 12 Check to Print - Does not print on the report. Controls what reports print. SunGard K-12 Education Copyright 2013 Page 4 of 10

6 IEPPLUS Evaluation/ReEvaluation Consent (Report) IEPPLUS Data Fields Additional Instructions A Maintenance, Manage Letterhead and/or User Defaults Report only - part of PWN. On the PWN form Check to Print When the Print Evaluation / Reevaluation Consent Form is checked, the - Report Header, footers Evaluation/ReEvaluation Consent report will print after the - District Logo Prior Written Notice. 1 Date Today s Date, allow users to change - Saves to Form Date Same as #2 in PWN 2 TO: Parent/Guardian/Surrogate & Adult Student 3 Student s Name Mail: Address Information 4 Reason for Consent request Basic Information, Contacts, Type = Parent/Guardian or Surrogate Parent & Mail Address - Mail Attention line if blank, use Contact name field First, Middle, Last names & Qualifier (ie John H. Jones Jr.) - Print one letter to each P/G indicated as receiving mail. - Generate student letter for student s age 18 as of date of meeting if no meeting attached. Maintenance, Manage Code Tables, Release/Waiver, Type = Adult Student exclusion, do not address letter to student. (Add to code tables via sql) Include student on the single parent letter when: - Form, Meeting, Student marked as Invited. - Form, Meeting, Meeting Reason = Secondary Transition Planning, Alternate Code = TP Basic Information, Contact, Contact Type = Parent / Guardian, and/or Surrogate Parent - Name, Address (Lines 1,2,City, State, Zip) - Mail Attention Line, if blank use Contact Name fields - Addresses Tab = Mail Check Boxes (3) - Data from PWN #6: Selecting Columns #2 = Initiate and Column #3 = Evaluation, Reevaluation and/or Other generates the Evaluation Consent report. SunGard K-12 Education Copyright 2013 Page 6 of 10

8 A IEPPLUS Data Fields Maintenance, Manage Letterhead and/or User Defaults Report Header, footers Client Logo 1 Student s Name 2 Student s SSID IEPPLUS Medicaid Verification Eligibility (Report) Additional Instructions Report only - part of PWN. IEPPLUS: WA Prior Written Notice On the PWN form Check to Print When the Print Evaluation / Reevaluation Consent Form is checked, the Medicaid Verification Eligibility report will print after the Prior Written Notice. Student > Demographics > First Name > Middle Name, Last Name, Qualifier (ie John James Jones III) Maintenance > Manage Code Tables > Table = Identification > Type = Student > Description = SSID > Alternate Codes > Alternate Code = SASID Student > Enrollment/Exit > Location (as of the PWN form Date): 3 Current School 4 Date of Birth Student, Demographics, DOB Maintenance > Manage Letterheads > Staff Type/Enclosure > District Contact & District Contact 5 District Contact Info & SunGard K-12 Education Copyright 2013 Page 8 of 10

9 VALIDATION RULES: PRIOR WRITTEN NOTICE Field Field Name 6 Purpose E 7 Action Proposed/Refus ed WA Prior Written Notice Validation Rules Warning Error Message / Error Rule 3 columns must have at least 1 check box Other must have text if checked Notice Purpose must have check in each column. E Must have text Missing text 8 Other Options W Warn when empty 9 Evaluations E Warn when empty Can be narrative or student Eval/Test records from linked IEP. 11 Action Initiated Warn when empty 12 Procedure Safeguard Contact E Procedure Safeguards Contact Missing -Can be narrative or staff table selection Do you need any other options considered text? Missing Evaluation / Test information Missing action initiated date. Missing Procedure Safeguard Contact Error Description Please insure columns 1, 2 and 3 have at least one box checked in each column. Please insure you complete the description and reason for proposed/refused action. The Other options considered text box is empty. Is this correct. If yes, ignore this warning. Please insure you have entered Evaluation / Test information that you used as the basis for this action. Please enter the appropriate date the PWN action will be initiated. Please enter the appropriate Procedure Safeguard Contact person. SunGard K-12 Education Copyright 2013 Page 9 of 10

10 REVISION HISTORY: 9/24/2013: Document reformatted to SunGard standards. All screenshots updated. Added header & footer records, page numbers, section titles, and a Table of Contents. Updated the existing screenshot for the Medicaid Verification Eligibility form. Added more details to the Medicaid Verification Eligibility Data Mapping fields #2, 3, and 5. 11/29/2011: Request to add Mark all items that apply 12/6/2011: Added ability to generate Consent form as part of the PWN. 12/8/2011: Added Medicaid Verification Eligibility form. 1/18/2012: Medicaid Eligibility Verification Form updated to change Department of Social Services Health DSHS to Washington State Healthcare Authority (HCA). Add of Student Signature Line on report. 2/22/2012: Updated to change screen shots of actual documents. SunGard K-12 Education Copyright 2013 Page 10 of 10

Illinois Referral Decision Form Instructions / User Guide IEPPLUS

Illinois Referral Decision Form Instructions / User Guide IEPPLUS 1990-2016 SunGard K-12. All rights reserved. No part of this publication may be reproduced without the prior written permission of SunGard