{"id":749,"date":"2024-01-03T01:21:47","date_gmt":"2024-01-03T01:21:47","guid":{"rendered":"https:\/\/kristenherzel.com\/kmh\/?page_id=749"},"modified":"2024-05-06T18:18:07","modified_gmt":"2024-05-06T18:18:07","slug":"parents-checklist","status":"publish","type":"page","link":"https:\/\/kristenherzel.com\/kmh\/parents-checklist\/","title":{"rendered":"Parents&#8217; Checklist"},"content":{"rendered":"\n<h4 class=\"wp-block-heading\" id=\"please-complete-and-bring-these-forms-to-your-first-testing-appointment\">Please complete and bring these forms to your first testing appointment<\/h4>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Developmental History Questionnaire<\/strong>&nbsp;form.&nbsp;&nbsp;&nbsp;<a href=\"https:\/\/kristenherzel.com\/kmh\/forms\/Developmental%20History%20Questionaire%20-%20Dr.%20Kristen%20Herzel.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">PDF<\/a>&nbsp;&nbsp;&nbsp;<a href=\"https:\/\/kristenherzel.com\/kmh\/forms\/Developmental%20History%20Questionaire%20-%20Dr.%20Kristen%20Herzel.doc\" target=\"_blank\" rel=\"noreferrer noopener\">DOC<\/a><\/li>\n\n\n\n<li><strong>Assessment Consent<\/strong> form. &nbsp;&nbsp;&nbsp;<a href=\"https:\/\/kristenherzel.com\/kmh\/forms\/Assessment%20Consent%20Form%20-%20Dr.%20Kristen%20Herzel.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">PDF<\/a><\/li>\n\n\n\n<li><strong>Confidential Authorization To Release Information<\/strong>.  You should complete one release for each person you would like me to talk to about your child. &nbsp;&nbsp;&nbsp;<a href=\"https:\/\/kristenherzel.com\/kmh\/forms\/Confidential%20Authorization%20To%20Release%20Information%20Form%20-%20Dr.%20Kristen%20Herzel.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">PDF<\/a><\/li>\n\n\n\n<li><strong>Email Agreement<\/strong> regarding email preferences. &nbsp;&nbsp;&nbsp;<a href=\"https:\/\/kristenherzel.com\/kmh\/forms\/Email%20Agreement%20Form%20-%20Dr.%20Kristen%20Herzel.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">PDF<\/a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Make sure to circle &#8216;yes&#8217; or &#8216;no&#8217; to indicate specific information you would or would not like me to include in any emails.<\/li>\n\n\n\n<li>Read about\u00a0<strong>Your Rights to Privacy under HIPAA<\/strong> \u00a0\u00a0\u00a0<a href=\"https:\/\/kristenherzel.com\/kmh\/forms\/HIPAA_Form.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">PDF<\/a>\u00a0\u00a0\u00a0\u00a0\u00a0<\/li>\n\n\n\n<li><strong>Acknowledgement of Receipt of Dr. Kristen Herzel&#8217;s Notice of Privacy Practices<\/strong> to indicate that you understand your rights under HIPAA rights.&nbsp;&nbsp;&nbsp;<a href=\"https:\/\/kristenherzel.com\/kmh\/forms\/Acknowledgement%20of%20Receipt%20of%20Notice%20of%20Privacy%20Practices%20Form%20-%20Dr.%20Kristen%20Herzel.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">PDF<\/a><\/li>\n<\/ul>\n\n\n\n<p>If your child is 14 years old or older, s\/he will be asked to sign all of the above forms, as well.<\/p>\n\n\n\n<p><strong>Please collect and bring these records, or email them to me at kherzel@gmail.com prior to our first appointment:<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Current IEP or Section 504 Service Agreement<\/li>\n\n\n\n<li>Previous evaluations from the school district, early intervention, medical providers, or other psychologists<\/li>\n\n\n\n<li>Standardized test results <\/li>\n\n\n\n<li>Any medical visit letters from your developmental pediatrician, psychiatrist or neurologist<\/li>\n<\/ul>\n\n\n\n<p>I prefer to receive records electronically, via email, dropbox and\/or flash drive.  However, where this is not possible, I will borrow copies of your paper records and return them after I&#8217;ve written the report. <\/p>\n\n\n\n<h4 class=\"wp-block-heading has-text-align-center\" id=\"school-visit-if-applicable\">SCHOOL VISIT (if applicable):<\/h4>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Please introduce me to your child&#8217;s teacher or case manager via e-mail.<\/li>\n\n\n\n<li>Sign a permission with the school district.<\/li>\n\n\n\n<li>Complete an&nbsp;<strong>Confidential Authorization to Release Information<\/strong>&nbsp;form (<a href=\"https:\/\/kristenherzel.com\/kmh\/forms\/Confidential%20Authorization%20To%20Release%20Information%20Form%20-%20Dr.%20Kristen%20Herzel.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">PDF<\/a>, discussed above) for the school. Circle \u201cobtain from,\u201d which means I will get information from the school but will not share any information with them.<\/li>\n\n\n\n<li>Provide me with names and phone numbers for teacher and principal.<\/li>\n\n\n\n<li>Let me know if you have any preference for what time of day I visit or what activities I observe.<\/li>\n\n\n\n<li>When I have the visit scheduled, please put that on your calendar in case you need to reach me if your child is sick or otherwise not in school.<\/li>\n\n\n\n<li>On the day of the scheduled observation, please text me at 610-541-0710 if it turns out that your child will be absent.<\/li>\n<\/ul>\n\n\n\n<figure class=\"wp-block-image size-large\"><img loading=\"lazy\" decoding=\"async\" width=\"1024\" height=\"731\" src=\"https:\/\/kristenherzel.com\/kmh\/wp-content\/uploads\/2024\/01\/March-27-1024x731.jpg\" alt=\"\" class=\"wp-image-889\" srcset=\"https:\/\/kristenherzel.com\/kmh\/wp-content\/uploads\/2024\/01\/March-27-1024x731.jpg 1024w, https:\/\/kristenherzel.com\/kmh\/wp-content\/uploads\/2024\/01\/March-27-300x214.jpg 300w, https:\/\/kristenherzel.com\/kmh\/wp-content\/uploads\/2024\/01\/March-27-768x549.jpg 768w, https:\/\/kristenherzel.com\/kmh\/wp-content\/uploads\/2024\/01\/March-27-1536x1097.jpg 1536w, https:\/\/kristenherzel.com\/kmh\/wp-content\/uploads\/2024\/01\/March-27-2048x1463.jpg 2048w\" sizes=\"auto, (max-width: 1024px) 100vw, 1024px\" \/><\/figure>\n","protected":false},"excerpt":{"rendered":"<p>Please complete and bring these forms to your first testing appointment If your child is 14 years old or older, s\/he will be asked to sign all of the above forms, as well. Please collect and bring these records, or email them to me at kherzel@gmail.com prior to our first appointment: I prefer to receive [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_gspb_post_css":"","footnotes":""},"class_list":["post-749","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/kristenherzel.com\/kmh\/wp-json\/wp\/v2\/pages\/749","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/kristenherzel.com\/kmh\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/kristenherzel.com\/kmh\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/kristenherzel.com\/kmh\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/kristenherzel.com\/kmh\/wp-json\/wp\/v2\/comments?post=749"}],"version-history":[{"count":9,"href":"https:\/\/kristenherzel.com\/kmh\/wp-json\/wp\/v2\/pages\/749\/revisions"}],"predecessor-version":[{"id":974,"href":"https:\/\/kristenherzel.com\/kmh\/wp-json\/wp\/v2\/pages\/749\/revisions\/974"}],"wp:attachment":[{"href":"https:\/\/kristenherzel.com\/kmh\/wp-json\/wp\/v2\/media?parent=749"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}