MedicaidAdministrativeMedium impact
Standardized Referral Form for Early Intervention
Illinois Medicaid - HFS·IL · Pediatrics, Family Medicine, General Practice·Provider Notice
Effective date
Jul 30, 2014
We identified it
Jun 20, 2026
Summary
Illinois has introduced a standardized referral form (Form 650) for Early Intervention services for children 3 years and younger with suspected developmental delays. Providers are strongly encouraged to use this form when referring to Department of Human Services Child and Family Connections offices, as it ensures proper HIPAA/FERPA compliance and establishes a feedback loop for referral outcomes.
Action Required
Immediately: Providers treating children 3 years and younger should download Form 650 (Standardized Illinois Early Intervention Referral Form) from the HFS Medical Program Forms webpage. Use this form for all developmental delay referrals to Child and Family Connections offices instead of informal referral methods. Update referral workflows to include this standardized form to ensure proper consent documentation and outcome tracking.