[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-1-en-105":3,"doc-seo-254648-105":53,"doc-detail-254648-en":127},{"code":4,"msg":5,"data":6},0,"success",[7,14,19,24,29,34,39,44,49],{"id":8,"doc_module":9,"doc_module_name":10,"category_name":11,"show_sort_weight":12,"slug":13},11,1,"Template","Presentations",90,"presentations",{"id":15,"doc_module":9,"doc_module_name":10,"category_name":16,"show_sort_weight":17,"slug":18},12,"Resumes",80,"resumes",{"id":20,"doc_module":9,"doc_module_name":10,"category_name":21,"show_sort_weight":22,"slug":23},14,"Invoices",70,"invoices",{"id":25,"doc_module":9,"doc_module_name":10,"category_name":26,"show_sort_weight":27,"slug":28},15,"Posters",60,"posters",{"id":30,"doc_module":9,"doc_module_name":10,"category_name":31,"show_sort_weight":32,"slug":33},16,"Social Media",50,"social-media",{"id":35,"doc_module":9,"doc_module_name":10,"category_name":36,"show_sort_weight":37,"slug":38},17,"Forms",40,"forms",{"id":40,"doc_module":9,"doc_module_name":10,"category_name":41,"show_sort_weight":42,"slug":43},18,"Letters",30,"letters",{"id":45,"doc_module":9,"doc_module_name":10,"category_name":46,"show_sort_weight":47,"slug":48},21,"Paper Templates",5,"papers-templates",{"id":50,"doc_module":9,"doc_module_name":10,"category_name":51,"show_sort_weight":4,"slug":52},158,"General","general-158",{"code":4,"msg":54,"data":55},"ok",{"site_id":56,"language":57,"slug":58,"title":59,"keywords":60,"description":61,"schema_data":62,"social_meta":120,"head_meta":122,"extra_data":124,"updated_unix":126},105,"en","sample-letter-for-a-physician-making-a-recommendation-for-special-education-eligibility-letter-template","Sample Letter for a Physician Making a Recommendation for Special Education Eligibility - Letter Template","","Professional recommendation letter template for a physician to submit to parents regarding a child’s eligibility for special education. The form prompts completion of date and child identifiers, documents the physician’s diagnosis and professional judgment, specifies required program components, and includes optional language covering administered or reviewed evaluations and observation reports. It also addresses the eligibility standard that disability must adversely affect education and requests a health assessment by a licensed professional to determine educational needs, concluding with an MD signature block.",{"@graph":63,"@context":119},[64,80,102],{"@type":65,"itemListElement":66},"BreadcrumbList",[67,71,74,77],{"item":68,"name":69,"@type":70,"position":9},"https://docshare.wps.com","Home","ListItem",{"item":72,"name":10,"@type":70,"position":73},"https://docshare.wps.com/template/",2,{"item":75,"name":41,"@type":70,"position":76},"https://docshare.wps.com/template/letters/",3,{"item":78,"name":59,"@type":70,"position":79},"https://docshare.wps.com/template/sample-letter-for-a-physician-making-a-recommendation-for-special-education-eligibility-letter-template/254648/",4,{"url":78,"name":59,"@type":81,"image":82,"author":87,"headline":59,"publisher":90,"fileFormat":93,"inLanguage":57,"description":61,"dateModified":94,"datePublished":95,"encodingFormat":93,"isAccessibleForFree":96,"interactionStatistic":97},"DigitalDocument",{"url":83,"@type":84,"width":85,"height":86},"https://docshare.wps.com/thumbnails/sample-letter-for-a-physician-making-a-recommendation-for-special-education-eligibility-letter-template/254648.png","ImageObject",442,249,{"name":88,"@type":89},"Gelato","Person",{"url":68,"name":91,"@type":92},"DocShare","Organization","application/pdf","2026-10-18","2026-09-13",true,{"@type":98,"interactionType":99,"userInteractionCount":101},"InteractionCounter",{"@type":100},"ViewAction",6,{"@type":103,"mainEntity":104},"FAQPage",[105,111,115],{"name":106,"@type":107,"acceptedAnswer":108},"What information must be included at the top of the letter?","Question",{"text":109,"@type":110},"The template requires the correspondence date and the child’s name, along with a greeting addressed to the parents.","Answer",{"name":112,"@type":107,"acceptedAnswer":113},"What professional judgment does the physician need to provide?",{"text":114,"@type":110},"The physician states a diagnosis (or concurs with another evaluator’s diagnosis) and explains that, due to the child’s disability, the child needs special education identification to receive a free appropriate public education.",{"name":116,"@type":107,"acceptedAnswer":117},"When should the optional evaluation paragraph be included?",{"text":118,"@type":110},"Include it when the physician administered tests or evaluation components or reviewed tests, evaluations, written observation reports, or behavior rating forms used to reach the conclusions.","https://schema.org",{"og:url":78,"og:type":121,"og:title":59,"og:site_name":91,"og:description":61},"article",{"robots":123,"canonical":78},"index,follow",{"doc_id":125,"site_id":56},254648,1790471393,{"code":4,"msg":5,"data":128},{"doc_id":125,"user_id":129,"nickname":88,"user_avatar":130,"doc_module":9,"category_id":40,"category_name":41,"doc_title":59,"doc_description":61,"doc_content":131,"file_id":132,"file_url":133,"file_type":134,"file_size":135,"view_count":101,"is_deleted":4,"is_public":9,"is_downloadable":9,"audit_status":9,"page_count":9,"language":136,"language_code":57,"site_id":56,"html_lang":57,"table_of_contents":137,"faqs":138,"seo_title":139,"seo_description":61,"update_tm":140,"read_time":4},19241457091524,"https://us-avatar.wpscdn.com/davatar_276721f389ce27ea32af1340a28f341c","Sample Letter  \nPlease note: It is very important that all correspondence be dated and that you keep a copy foryour records. SAMPLE LETTER FOR A PHYSICIAN MAKING A RECOMMENDATION THAT A CHILD BE FOUND ELIGIBLE FOR SPECIAL EDUCATION OR PROVIDING RECOMMENDATIONS FOR  \nTHE CHILD’S SPECIAL EDUCATION AND RELATED SERVICES  \nNOTE: Letter to be sent to the parents who will then enclose a copy with a cover letter from them to the Case Manager, Special Education Director or Principal  \n[ Date]  \nDear---------------  \n[ Name of child] is my patient. I have made a diagnosis [or concur with the diagnosis made by   [name of other evaluator]] of [provide the full name of the disability or health condition] . Given his/her disability, it is my professional judgment that, in order for [ name of child] to receive a free appropriate public education, he/she requires special education identification and [specify program components] .  \n[Note: Include the following paragraph if appropriate]: I have administered [name of test[s] or evaluation components] and/or have reviewed the tests or evaluations or written observation reports of [ name of evaluator] or behavior rating forms completed by [ name of child]’s parents and/or teachers in order to reach my conclusions.  \nI am aware that, in order to be determined eligible for special education services, a child must have a disability and that disability must adversely his/her education. My assessment of [ name of child] meets the requirement that a child who has, or is suspected of having [ identify which of the following disability categories reflects the child’s diagnosis/disability: autism, orthopedic impairment, other health impairment or traumatic brain injury] be provided with a “health assessment” by a “professional licensed to provide a health assessment” as part of the evaluation to determine eligibility and identify the child’s educational needs.  \nI appreciate this opportunity to provide you with information to assist you in providing [ name of child], with the special education and related services he/she needs.  \nVery truly yours,[Name of MD]  \nThis document is provided for informational purposes only; it does not, nor is it intended to, constitute legal advice. For more information on the special education process, and upcoming workshop opportunities, please visit our [website at](website at www.nhspecialed.org . Be sure)[ ](website at www.nhspecialed.org . Be sure)[www.nhspecialed.org](website at www.nhspecialed.org . Be sure)[ . Be sure](website at www.nhspecialed.org . Be sure) to read our brochure, “Steps in the NH Special Education Process”.","cbCaiirYHtFw3hF2","https://ap.wps.com/l/cbCaiirYHtFw3hF2","pdf",64851,"English","# Sample Letter\n## Physician Recommendation Content\n## Signature and Document Notes","[{\"question\":\"What information must be included at the top of the letter?\",\"answer\":\"The template requires the correspondence date and the child’s name, along with a greeting addressed to the parents.\"},{\"question\":\"What professional judgment does the physician need to provide?\",\"answer\":\"The physician states a diagnosis (or concurs with another evaluator’s diagnosis) and explains that, due to the child’s disability, the child needs special education identification to receive a free appropriate public education.\"},{\"question\":\"When should the optional evaluation paragraph be included?\",\"answer\":\"Include it when the physician administered tests or evaluation components or reviewed tests, evaluations, written observation reports, or behavior rating forms used to reach the conclusions.\"}]","Sample Letter for a Physician Making a Recommendation for Special Education Eligibility - Letter Template | PDF",1789280285]