Completing the Fax Back Referral Form

Description Developed by a collaborative project of the Illinois Chapter of the American Academy of Pediatrics, Advocate Health Care's Healthy Step Program, the Illinois Bureau of Early Intervention, and the Early Intervention Training Program at the University of IL, this project was supported by a grant from the Commonwealth Fund.

Within this brief training module, you will learn how to fill out the Referral Fax Back Form (Parts I & II) and be reminded of the importance of ensuring strong communication with referral sources and primary care providers throughout the process.

Participants must complete the training module, successfully pass the quiz, and complete the required training evaluation in order to receive a certificate of completion.

Please note that Flash Version 9 or better is required to play the online modules. Flash can be downloaded from at no charge. Please keep in mind that this excludes iPads and iPhones and other devices that don’t support flash.

A Moodle account is required to access this training. If you do not have a Moodle account you will have the opportunity to request one via a link in your confirmation email. Please note that it may take up to two business days to process new Moodle account requests.

Location Online

Date 2/13/2014 8:00 AM - 6/30/2016 11:45 PM
Sponsor Early Intervention Training Program at the University of Illinois
Contact EI Training Program at the U of I (866) 509-3867
Level Beginner
Principles 1. Support families
3. Collaborative relationships
8. Quality services
Credit Hours 0.5 - Intervention
Cost No Charge
Cut Off Date 6/30/2016
Status Closed