(a) The following primary referral sources shall, within two working days of identifying an infant or toddler who is less than three years of age and suspected of having a disability or at risk of having a disability, refer such infant or toddler to the official designated by the municipality, unless the child has already been referred or unless the parent objects: all individuals who are qualified personnel; all approved evaluators, service coordinators, and providers of early intervention services; hospitals; child health care providers; day care programs; local health units; local school districts; local social service districts including public agencies and staff in the child welfare system; public health facilities; early childhood direction centers; domestic violence shelters and agencies; homeless family shelters; and, operators of any clinic approved under article 28 of Public Health Law, article 16 of the Mental Hygiene Law, or article 31 of the Mental Hygiene Law.

1. (1) A primary referral source who has identified an infant or toddler suspected of having a disability shall:

   1. (i) provide a general explanation of the services that are available under the Early Intervention Program and the benefits to the child’s development and to the family of accessing those services;
   2. (ii) inform the parent that, unless the parent objects, their child will be referred to the early intervention official for purposes of a free screening and/or multidisciplinary evaluation or, with parent permission, a review of medical or other records to determine eligibility for services;
   3. (iii) whenever feasible, inform the parent about such referral in their dominant language or other mode of communication; and
   4. (iv) ensure the confidentiality of all information transmitted at the time of referral.

2. (2) A primary referral source who has identified an infant or toddler at risk of a disability shall:

   1. (i) provide a general explanation of the developmental screening, home visiting, and tracking services that are available to the family, including municipal child find programs and the benefits to the child’s development and to the family of accessing those services;
   2. (ii) inform the parent that, unless the parent objects, their child will be referred to the designated county official for the purposes of developmental screening, home visiting, and tracking services, which may include enrollment in municipal child find programs;
   3. (iii) whenever feasible, inform the parent about such referral in their dominant language or other mode of communication; and
   4. (iv) ensure the confidentiality of all information transmitted at the time of referral.

3. (3) When a parent objects to the referral the primary referral source shall:

   1. (i) maintain written documentation of the parent’s objection to the referral and follow-up actions taken by the primary referral source;
   2. (ii) provide the parent with the name and contact information of the early intervention official if the child is suspected of having a disability or if the child is at-risk; and
   3. (iii) within two months, make reasonable efforts to follow-up with the parent, and if appropriate, refer the child unless the parent objects.

(b) Information transmitted in a referral from a primary referral source, for an infant or toddler suspected of having a disability or at risk of developing a disability, shall consist of only the following information, unless written consent is obtained from a parent to the transmittal of further information to the early intervention official:

1. (1) the child’s name, sex, race, ethnicity, and birth date;
2. (2) the name, address and telephone number of the parent and/or if applicable, the person in parental relation to the child;
3. (3) when necessary and applicable, the name and telephone number of another person through whom the parent may be contacted;
4. (4) if the child is being referred because he or she is at risk of developing a disability, the referral shall include an indication that the child is not suspected of having a disability, but is at risk of developing a disability in the future; and
5. (5) name and telephone number of the primary referral source.

(d) Referrals of children suspected of having a disability, which includes a developmental delay and/or a diagnosed physical or mental condition that has a high probability of resulting in developmental delay, shall be based on:

1. (1) the results of a developmental screening or diagnostic procedure(s); direct experience, observation, and perception of the child’s developmental progress;
2. (2) information provided by a parent which is indicative of the presence of a developmental delay or disability;
3. (3) or a request by a parent that such referral be made.

(e) Primary referral sources identified in subdivision (a) of this section shall, with parental consent, complete and transmit at the time of referral, a referral form developed by the department. The referral form shall contain information sufficient to document the primary referral source’s basis for suspecting the child has a disability or is at risk of having a disability. Where applicable, the referral form shall specify the child’s diagnosed condition, or the child’s level of functioning in one or more developmental areas, that may constitute a developmental delay that may establish the child’s eligibility for the Early Intervention Program. The primary referral source shall inform the parent of a child with a diagnosed condition that has a high probability of resulting in developmental delay, or a diagnosed level of delay consistent with eligibility requirements in section 69-4.23(a)(2) of this Subpart:

1. (1) that eligibility for the program may be established by medical or other records; and
2. (2) of the importance of providing consent for the primary referral source to transmit records or reports necessary to support the diagnosis, or, for parents or guardians of children who do not have a diagnosed condition, records or reports that would assist in determining eligibility for the program.

(f) Diagnosed physical and mental conditions with a high probability of developmental delay include:

1. (1) chromosomal abnormalities associated with developmental delay (e.g., Down Syndrome);
2. (2) syndromes and conditions associated with delays in development (e.g., fetal alcohol syndrome);
3. (3) neuromuscular disorder (e.g., any disorder known to affect the central nervous system, including cerebral palsy, spina bifida, microcephaly or macrocephaly);
4. (4) clinical evidence of central nervous system (CNS) abnormality following bacterial/viral infection of the brain or head/spinal trauma;
5. (5) hearing impairment (a diagnosed hearing loss that cannot be corrected with treatment or surgery);
6. (6) visual impairment (a diagnosed visual impairment that cannot be corrected with treatment [including glasses or contact lenses] or surgery);
7. (7) diagnosed psychiatric conditions, such as reactive attachment disorder of infancy and early childhood; (symptoms include persistent failure to initiate or respond to primary caregivers; fearfulness and hypervigilance that does not respond to comforting by caregivers; absence of visual tracking); and
8. (8) emotional/behavioral disorder (the infant or toddler exhibits atypical emotional or behavioral conditions, such as delay or abnormality in achieving expected emotional milestones such as pleasurable interest in adults and peers; ability to communicate emotional needs; self-injurious/persistent stereotypical behaviors).

(g) Referrals of children at risk of having a disability shall be made based on the following medical/biological risk factors:

1. (1) Medical/biological neonatal risk criteria, including:

   1. (i) birth weight less than 1501 grams;
   2. (ii) gestational age less than 33 weeks;
   3. (iii) central nervous system insult or abnormality (including neonatal seizures, intracranial hemorrhage, need for ventilator support for more than 48 hours, birth trauma);
   4. (iv) congenital malformations;
   5. (v) asphyxia (Apgar score of three or less at five minutes);
   6. (vi) abnormalities in muscle tone, such as hyper- or hypotonicity;
   7. (vii) hyperbilirubinemia (> 20mg/dl);
   8. (viii) hypoglycemia (serum glucose under 20 mg/dl);
   9. (ix) growth deficiency/nutritional problems (e.g., small for gestational age; significant feeding problem);
   10. (x) presence of inborn metabolic disorder (IMD);
   11. (xi) perinatally- or congenitally-transmitted infection (e.g., HIV, hepatitis B, syphilis);
   12. (xii) 10 or more days hospitalization in a neonatal intensive care unit (NICU);
   13. (xiii) maternal prenatal alcohol abuse;
   14. (xiv) maternal prenatal abuse of illicit substances;
   15. (xv) prenatal exposure to therapeutic drugs with known potential developmental implications (e.g., psychotropic medications, anticonvulsant, antineoplastic);
   16. (xvi) maternal PKU;
   17. (xvii) risks of hearing loss based on family history, including syndromal presentation, or failure of initial newborn infant hearing screening and the child is in need of follow-up screening;
   18. (xviii) risk of vision impairment, including family history of conditions causing blindness or severe vision impairment; and
   19. (xiv) presence of a genetic syndrome that may confer increased risk for developmental delay, except for those syndromes such as Down syndrome which require referral of the child as suspected of having a disability in accordance with subdivisions (d) and (e) of this section.

2. (2) Medical/biological post-neonatal and early childhood risk criteria, including:

   1. (i) parental or caregiver concern about developmental status;
   2. (ii) serious illness or traumatic injury with implications for central nervous system development and requiring hospitalization in a pediatric intensive care unit for 10 or more days;
   3. (iii) elevated venous blood lead levels (at or above 15 mcg/dl);
   4. (iv) growth deficiency/nutritional problems (e.g., significant organic or inorganic failure-to-thrive, significant iron-deficiency anemia);
   5. (v) chronicity of serous otitis media (continuous for a minimum of three months);
   6. (vi) HIV infection;
   7. (vii) indicated case of child abuse or maltreatment.

(h) The following risk criteria may be considered by the primary referral source in the decision to make a referral:

1. (1) no prenatal care;
2. (2) parental developmental disability or diagnosed serious and persistent mental illness;
3. (3) parental substance abuse, including alcohol or illicit drug abuse;
4. (4) no well child care by six months of age or significant delay in immunizations; and/or
5. (5) other risk criteria as identified by the primary referral source.