PRP & Respite Referrals

Please use this page for PRP & Respite Referrals in the state of Maryland.  For all other referrals, please abide by the established referral process for your contract.  Thank you, and we look forward to working with you!

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A complete referral will include:

  • DSM-V diagnosis

  • Individual who diagnosed the child

  • Date child was diagnosed

  • Name and telephone number of current psychologist/psychiatrist

  • Treatment modality and frequency

  • Current medications

  • Family history

  • Any history related to current need for Respite

  • Copy of the child’s ITP/IRP

  • Consent to exchange information

  • POC = Plan of Care if 1915i Approved

Forms for Specific Counties in Maryland:

Baltimore City & All Other Counties:

FAX completed form to 410-643-9293