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Medical Professionals

Physicians/PsychiatristsGeneral education students in grades K-12 may be eligible for service from Home & Hospital if: they have a medically verified, non-contagious physical condition(s) or a temporary physical disability that cannot be accommodated at their home school. 

A Physician/Psychiatrist referral must be completed and signed by a California licensed physician or psychiatrist and include a diagnosis as well as an estimated return date.  The return date may not exceed 90 days.

Please complete,  print, and sign the form and return to the student’s home school. 

Students referred to H&H must have a medical or psychological condition, verified by a licensed doctor.

PHYSICIAN/PSYCHIATRIST FORM 

  • States the need for Home/Hospital Instruction.

  • Student must be out of school for 15 days or more.  

  • The referral may not exceed 90 days.

Eligibility will be reviewed every 90 days and requires a new medical or psychiatric referral to extend services.

 

 

*Note for Kaiser Patients: Parents may also send the blank form to the ROMI Diablo Area Office at DSAROMI@kp.org. Completed forms are returned to you, rather than to a third party, so you can review the information and make a copy for your records first. The completed form should then be sent with the completed application forms to the student's home school to complete the registration process at Home & Hospital.