juveniletop.gif (3232 bytes)       

ctop_2.gif (641 bytes)ctop_3.gif (1177 bytes)
                                                                                                                        home.gif (1409 bytes)feedback.gif (1665 bytes)

How to Make a SPRITE Referral

 

To Complete the Forms by Computer, follow the directions below.
 

Please print this page to use as a referral checklist. Then print each form or save to your computer.

HOW TO MAKE A DIRECT COUNTY REFERRAL TO THE 24-DAY SPRITE PROGRAM, OREGON, WI

1.  Make an initial phone call to verify the student fits the selection criteria and that there are openings.  The SPRITE main office number is (608) 288-3356.

 2.  Send via mail, fax or email:

o   SPRITE Referral and Face Sheet (DOC-1615)

o   County worker’s email address and fax number; After-hours phone

o   Current court report and social history

To: SPRITE Program, Attn: Jo Mercurio, Supervisor, 2909 Landmark Place,     Suite 104  Madison, WI  53713 Phone: 608.288.3356 Cell: 608.235.6387 Fax: 608.288.3378  email: joann.mercurio@wi.gov

3. Obtain and send appropriate authorizations, health information and signatures

o    Emergency medical care authorization for a minor (DOC-2196) signed by parents/guardian.  (Include name of  insurance carrier and group/patient number or  MA number if applicable)

o    Physician Recommendation (DOC-2272 rev. 1/2010)

o    Psychiatrist Recommendation if youth is on psychotropic medication or has been under a psychiatrist’s care. See list of inclusive medications on the 

  Psychiatrist Recommendation (DOC-2273 rev. 1/2008)

o     Authorization for Use and Disclosure of Protected Health Information (DOC-1163A rev. 12/2007) allowing SPRITE to receive information from physicians or urgent care facilities.

4. Get student court-ordered to SPRITE. Judges may use WI Stat. 938.34 (7g) or make   SPRITE participation a condition of dispositional order.

5.  Schedule youth’s interview date.  All youth are required to have an interview either in person (if possible) or by the telephone.  

To allow for SPRITE preparation please try to transmit all remaining material to SPRITE fourteen (14) days prior to the start of the session. 

6. If not completed during youth’s interview, send the completed Student Questionnaire (DOC-1706) and Rules and Expectations (DOC-1760)

7.  Interagency Agreement (DOC-2245) 

8.  Copy of the Court Order requiring participation in SPRITE.

The County is responsible for transportation of the student to and from the SPRITE Program.  County students must arrive at the SPRITE House between 11:00 a.m. and 12:00 noon on the first day of the session.  

Graduation is at 10 a.m. on the final day of the session.  Thank you.

Please print the 2009 SPRITE schedule and map to SPRITE.

 

DJC Home