Referring Providers,

Thank you for referring to the Division of Developmental-Behavioral Pediatrics at the UAB Civitan-Sparks Clinics. Please review the following information regarding requirements for submission of referrals.

We are currently prioritizing children 5 and under with a concern for Autism. All previously referred patients will remain on our wait list.

The following documents are REQUIRED or the referral will be rejected:

• Developmental-Behavioral Pediatrics Patient Information Request Form (located on the appointments page)
• EPSDT Cascading Referral (if patient has Medicaid)
• The note(s) from the most recent office visit and/or any that describe concerns relevant to the reason for referral, including copies of any completed developmental screening measures (e.g. ASQ, MCHAT-R/F, etc.)

The following documents are appreciated if available:

• IFSP (Individualized Family Service Plan) from the child’s Early Intervention Services
• Individualized Education Plan and Eligibility Report Form from the patient’s school
• Copies of previous developmental/psychological testing
• Information on any other referrals made for the same concerns (i.e. to other psychologists, psychiatrists, subspecialty providers, service/therapy providers, etc.)

We appreciate your help in this process and look forward to working with you.

Sincerely,
Division of Developmental-Behavioral Pediatrics
UAB Civitan-Sparks Clinics