This document contains California's guidelines for serving students with severe orthopedic impairments in the public schools. Elements characteristic of well-designed programs are described in the guide's three chapters, and each description is followed by a series of questions for program evaluation. The first chapter addresses approaches to identification and assessment, covering medical condition, ability and achievement, communication skills, physical education, social and emotional characteristics, independent living skills, and career and vocational education plans. Chapter 2 deals with planning and service provision, and includes such topics as curriculum continuity, appropriate physical education, mobility training, career and vocational education, and proficiency standards. Chapter 3 examines organization and support, reviewing educational program options, infant and preschool programs, staff, parents' and pupils' support for the total program, and special considerations, such as specialized medications, emergency procedures, equipment and transportation. Appended material includes a self-review guide to help improve program effectiveness, a glossary, and excerpts from relevant legislative codes. (CL)