Assessment Referrals Matrix

Know what you are looking for?
Jump to CCSCPMCCBHS, DPHMDACGGRC Early Start, GGRC Lanterman, SFUSD Early StartSFUSD PreschoolSFUSD TK-12SFUSD Private Placement

California Children’s Services (CCS)

30 Van Ness, Suite 210
San Francisco CA 94102

415-575-5700

San Francisco Website | California Website

Category Ages Insurance Language Timeline

0-21

English
Spanish
Cantonese
Mandarin
Korean
Tagalog

60 days

Referral Process
Referral Medical Info Needed Family/Parent Docs

Families will complete the English CCS Application or Spanish CCS Application​​ and return it to your county CCS office

Providers will use Application to Determine CCS Program Eligibility (DHCS 4480, 01/22)
Alt: Spanish​

Detailed medical reports

  • CCS Application Form
  • Proof of residence
  • Income documentation
  • Insurance info
  • consent forms

California Pacific Medical Center (CPMC)

1625 Van Ness, 3rd Floor
San Francisco, CA 94107

415-600-6200
Website

Category Ages Insurance Language Timeline

0-18

Medi-Cal
Healthy Families

Uninsured

English
Spanish

60 days

Referral Process
Referral Medical Info Needed Family/Parent Docs

Parent calls to start intake process

  • Insurance info
  • CPMC Intake packet
  • general consent form

Department of Public Health: Community Behavioral Health Services (CBHS)

1380 Howard St, 1st Floor
San Francisco, CA 94103

415-255-3737

Website

Category Ages Insurance Language Timeline

0-18

Medi-Cal
Healthy Kids

Uninsured

All Languages

10 days

Referral Process
Referral Medical Info Needed Family/Parent Docs

Parent calls central access number or walks in to any civil service clinic to start intake process

Detailed medical reports

  • Insurance information
  • consent to share medical information
  • Proof of residency

Multi-Disciplinary Assessment Center (MDAC)

SF General Hospital, UCSF Department of Pediatrics

1001 Potrero Ave, MS 6E (mailing address)
Main Hospital Building, 6B (physical location)
San Francisco, CA 94110

415-206-6129
[email protected]

Website

Category Ages Insurance Language Timeline

Developmental or behavioral concerns, including:

  • Gross/Fine Motor Delays
  • Speech/Language
  • Social Development
  • Atypical Behaviors
  • Learning or Cognitive Problems
  • Behavioral Problems
  • Aggressive Behaviors
  • Chronic Illness or Genetic Condition
  • ADHD

0-5
Insurance N/A

6-18
Insurance required

Medi-Cal
Healthy Kids
A variety of private health insurances, please check your coverage plan

English
Spanish

60 days

Referral Process
Referral Medical Info Needed Family/Parent Docs Consent Forms

Primary Care Provider emails or faxes MDAC Referral Form [pdf] to start intake process

Copies of previous assessments if available

  • Proof of residency
  • Insurance info (if 6-18)

General consent form

Golden Gate Regional Center (GGRC) Early Start Services

1355 Market St, #220
San Francisco, CA 94103

888-339-3305
[email protected]

Website

Referral Process (Age 0-3)
Category Ages Insurance Language Timeline

0-3

Medi-Cal, Private Insurance or
Uninsured

English
Spanish
Cantonese
Mandarin

45 days

Referral Medical Info Needed Family/Parent Docs

Provider emails or faxes Early Start Referral Form [pdf], or parent emails or faxes Early Start Intake Form [doc] to start intake process

Medical and
Developmental
Reports

Golden Gate Regional Center (GGRC) Lanterman Services

1355 Market St, #220
San Francisco, CA 94103

888-339-3305
[email protected]

Website

Referral Process (Age 3+)
Category Ages Insurance Language Timeline

Developmental disability defined as:

  • Intellectual Disability (or closely related condition)
  • Cerebral Palsy
  • Epilepsy
  • Autism
3+
Any Insurance Uninsured
English Spanish Cantonese Mandarin
120 days
Referral Medical Info Needed Family/Parent Docs

Parent calls intake line to start intake process

(If you are a provider, call intake line with parents to initiate the process )

Relevant medical reports

San Francisco Unified School District Early Start (SFUSD Early Start)

Phone: (415) 401-2525 x1101
Email: [email protected]

Website

Referral Process
Category Ages Insurance Language Timeline

Solely low incidence disability:

  • Hearing Impairment
  • Vision Impairment
  • Severe Orthopedic Impairment
  • or a combination thereof

0-3

N/A

English
Spanish
Cantonese
Mandarin (more languages via interpretation services)

45 days

Referral Medical Info Needed Family/Parent Docs

Typically referred by GGRC or child’s doctor. Child may also be referred by parent.

Medical Report indicating solely low incidence disability

Proof of residency in San Francisco

San Francisco Unified School District Preschool (SFUSD Preschool)

Phone: (415) 401-2525 x1101
Email: [email protected]

Website

Category Ages Insurance Language Timeline
  • Autism
  • Deaf-blindness
  • Deafness
  • Emotional Disturbance
  • Hearing Impairment
  • Intellectual Disability
  • Multiple Disabilities
  • Orthopedic Impairment
  • Other Health Impairment
  • Specific Learning Disabilities
  • Speech and Language Impairment
  • Traumatic Brain Injury
  • Visual Impairment
  • Established Medical Disability

3-5

Insurance is not considered or used

English
Spanish
Cantonese
Mandarin
(more languages via interpretation services)

15 days to respond to referral 

Referral Process
Referral Medical Info Needed Family/Parent Docs

Family/parent sends written request for assessment for special education to [email protected]. If the child is in Early Start, GGRC will send the request for assessment.

Any pertinent medical reports are requested, but not required unless child has a vision impairment.

Parents must send in a completed intake packet with supporting documents (Proof of Residency, Birth Certificate, hearing/vision screening results if available)

San Francisco Unified School District TK/K - 12 (SFUSD TK-12)

Enrolled in Transitional Kindergarten(TK)/Kindergarten(K) through 12th grade with SFUSD

Contact depends on the school site of attendance. Generally, start by contacting the school principal.

415-759-2206

Website

Category Ages Insurance Language Timeline
  • Autism
  • Deaf-blindness
  • Deafness
  • Emotional Disturbance
  • Hearing Impairment
  • Intellectual Disability
  • Multiple Disabilities
  • Orthopedic Impairment
  • Other Health Impairment
  • Specific Learning Disabilities
  • Speech and Language Impairment
  • Traumatic Brain Injury
  • Visual Impairment

5-22

Insurance is not considered or used

English
Spanish
Cantonese
Mandarin (more languages via interpretation services)

15 days to respond to referral 

Referral Process
Referral Medical Info Needed Family/Parent Docs

Parent or provider submits request for assessment, in writing, to the child’s SFUSD school site.  

Sample Request for Assessment Letter English [doc]

Any pertinent medical reports are requested, but not required.

Families must sign the assessment plan before assessments may begin. 

Families may also wish to sign consent forms for release of information for any additional information they would like shared.  Information may not be shared without consent.

Private, Parochial Elementary, Middle, or High School OR Home-Schooled

Screening and Assessment Center (Central Office) *
3045 Santiago St
San Francisco, CA 94116

415-759-2206 

Website

Category Ages Insurance Language Timeline
  • Autism
  • Deaf-blindness
  • Deafness
  • Emotional Disturbance
  • Hearing Impairment
  • Intellectual Disability
  • Multiple Disabilities
  • Orthopedic Impairment
  • Other Health Impairment
  • Specific Learning Disabilities
  • Speech and Language Impairment
  • Traumatic Brain Injury
  • Visual Impairment

5-22

Insurance is not considered or used

English
Spanish
Cantonese
Mandarin (more languages via free interpretation services)

15 days to respond to referral

Referral Process
Referral Medical Info Needed Family/Parent Docs

Parent or provider submits request for assessment, in writing, to the child’s SFUSD school site.  

Sample Request for Assessment Letter English [doc]

Any pertinent medical reports are requested, but not required.

Families must sign the assessment plan before assessments may begin. 

Families may also wish to sign consent forms for release of information for any additional information they would like shared.  Information may not be shared without consent.

Read more about Assessments & Screenings

Doctors can unlock Services

Doctors play a crucial role in identifying and directing families with special health care needs and disabilities to the support programs available to assist them. Some things that doctors may

Read More

GGRC Guide to Understanding Services

Golden Gate Regional Center has created a variety of literature to aid individuals and families who are receiving or who may be interested in receiving services from the regional center. Much of that

Read More

Developmental Milestones from CDC

The Centers for Disease Control and Prevention (CDC) and the American Academy of Pediatrics (AAP) have revised developmental milestones in the “Learn the Signs. Act Early.” program, which helps parents identify autism

Read More

Explaining Early Start and Lanterman Services

ARCA Resources on How Service Starts for Early Start and Lanterman ServicesAll presentations include ASL interpretation. New infographics are linked at the end.PDF Slides // Diapositivas en PDF Family Perspective – An Unplanned Journey // Perspectiva

Read More

Understanding EPSDT

The California Screening Collaborative has released a publication around Early and Periodic Screening, Diagnostic, and Treatment (EPSDT). EPSDT is the route that enables families with Medi-Cal to receive mental health

Read More