CHEO Clinic for Augmentative Communication (CAC) Writing Aids Referral Form

The Writing Aids service is for those clients with a physical disability who need tools to assist them with producing written work.

The Writing Aids service at the Clinic for Augmentative Communication (CAC) is for children and youth who have a physical disability and require tools to assist them with producing written work. The information on this form will help us determine whether a Writing Aids Assessment through the CAC is the most appropriate service to meet the client's needs at this time.

To be eligible for writing aids funding through the Clinic for Augmentative Communication (CAC), the client must:

1. Have a long-term physical disability that precludes written communication without the use of specialized equipment.

2. Require an augmentative or alternative communication aid to enhance or replace written output for a period of six (6) months or longer.

3. Have regular and ongoing needs at home to independently perform writing-related tasks.

4. Be able to generate basic ideas independently in writing (using a pencil or keyboard, or by dictating letter by letter to an adult).

Note: Eligibility may be extended to children under the age of 6 with a physical disability who can:

  • - Recognize some letters
  • - Have some sight words
  • - Who have great difficulty with age-appropriate pen and paper tasks
  • - Who are not able to access a standard keyboard and mouse

A confirmation letter of either acceptance or denial to service will be sent to you. Please contact CHEO Access Team to confirm receipt of referral if you have not received a confirmation letter within 4-6 weeks.
I have reviewed the Writing Aids eligibility requirements on the CHEO website
Consent

I, the referral source, have obtained child/youth/parental/legal guardian consent to complete this referral for CHEO Clinic for augmentative communication (CAC). I have reviewed with the child/youth/parental/legal guardian that the information collected, used, and disclosed will be used to determine eligibility for an assessment at CAC and that this consent can be withdrawn at any time.

Who is completing this form?
Is the child/youth currently accessing Occupational Therapy (OT) services from any of the following agencies?

Does the legal guardian provide consent for CAC to send a referral questionnaire to the child/youth's occupational therapist to obtain additional information relating to their communication abilities and needs?
Information about the child
Does the client have a long-term physical disability affecting handwriting and/or typing?
Are there any concerns with the client's vision?
Are there any concerns with the client's hearing?
Can the client recognize at least 5 letters of the alphabet and some sight words?
Can the client communicate a basic idea in writing, i.e. write a simple sentence*(using a pencil or keyboard, or by dictating letter by letter to an adult)? *Perfect spelling and grammar are not required. For non-speaking clients, ideas may be conveyed through symbols.
Does the client have a need to produce written work at home (i.e. homework, diary, email, lists, etc.)
Would the client be expected to produce written work at home (like expectations for peers/classmates) if they had a means of writing which was faster and less tiring?
Check all that apply to the client regarding;
Printing/Handwriting

Typing

List computer adaptations that have already been tried:

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