Early Intervention: Provider Policies, Procedures and Forms - NYC Health

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Early Intervention: Provider Policies, Procedures and Forms

Procedures

NYC EI Policy and Procedure Manual (PDF)

EI-Hub Implementation and Revised Policy and Procedure Frequently Asked Questions (PDF)

Self-Assessment Tool for New York City EIP Providers (PDF)

Citations for Self-Assessment Tool:

Evaluation Citations (PDF)

Initial Service Coordination Citations (PDF)

Ongoing Service Coordination Citations (PDF)

Service Provision Citations (PDF)

Transition Citations (PDF)

Forms

Article 47 — Early Intervention Professionals in Child Care Settings

Letter from Assistant Commissioner (PDF)

Notification of Assignment of Professional Consultant Form (PDF)

Professional Consultants in Child Care — Summary of Changes to Child Care Regulations (PDF)

Assignment and Change in Service, Service Provider, Service Coordinator (Fillable PDF)

Assistive Technology Information Exchange Form (Fillable PDF)
CH205 (Child & Adolescent Health Examination Form) (PDF)

Closure Form (Fillable PDF)

Consent for Additional Evaluation (Fillable PDF)
Consent for Evaluation or Screening (PDF)

Consent Form for Transition Conference (Fillable PDF)

Consent Form for Transmittal of EIP Evaluations and Records to the Committee on Preschool Special Education (Fillable PDF)

Consent to Obtain and Release Information (PDF)

Early Intervention Hub Data Change Form (Fillable PDF)

Early Intervention Program Mileage Reimbursement Form (Fillable PDF)

Early Intervention Referral Form (PDF)

Evaluation Agency MDE and Screening Submission Checklist (PDF)

Family Concerns, Priorities, and Resources (PDF)

Foster Care Surrogacy Recommendation and EIOD Assignment (PDF)

Functional Outcomes Assistant and Instructions (PDF)

Group Session Note Version 1 (Fillable PDF)

Group Session Note Version 2 (Fillable PDF)

IFSP Meeting Consent for Services (Fillable PDF)

IFSP Scheduling Forms

Manhattan (Fillable PDF)

Brooklyn (Fillable PDF)

Bronx (Fillable PDF)

Queens (Fillable PDF)

Staten Island (Fillable PDF)

Initial Service Coordination Consents (PDF)

Initial Service Coordination Duration, Unit or Assignment Change (PDF)

Justification for Change in Frequency Intensity or Length of Services (Fillable PDF)
Multidisciplinary Evaluation Summary (PDF)

Notice of IFSP Meeting (Fillable PDF)

Notification of AT Item Delivery w/Instructions (Fillable PDF)

Notification to Foster Care Agency of Transition Out of Early Intervention (Fillable PDF)
Notification of Potential Eligibility to CPSE (Fillable PDF)

NYCEIP AT Medical Necessity Justification Form with Instructions (Fillable PDF)

Parent Consent for Public Transportation or Mileage Reimbursement (PDF)

Parent Designation of Person Acting in Place of Parent (PDF)

Parent Form: Written Notification and Written Opt-Out Requirements and Timeline (Fillable PDF)

Parent Referral to CPSE (Fillable PDF)

Progress Note (Fillable PDF)

Reason for Delay in Evaluation Completion and MDE Submission (PDF)

Reassignment or Termination of Surrogacy (PDF)

Request for Additional Evaluation (Fillable PDF)
Request for County and Borough Transfer (Fillable PDF)
Request for Foster Care Surrogacy Determination Letter (PDF)

Request for Mediation and Parental Consent to Release Information (Fillable PDF)

Request for Sign Language Interpreter (PDF)

Screening Summary (PDF)

Service Log (Fillable PDF)

Session Note Version 1 (Fillable PDF)

Session Note Version 2 (Fillable PDF)

Status of Start Date of Services (Fillable PDF)

Steps Taken to Determine Need for Surrogate Parent (PDF)

Your Family Rights in Early Intervention (PDF)

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Additional Resources

Resource Guide for Families of Children with Developmental Delays or Disabilities: 2017 (PDF)

Assistive Technology: Tools to Help Your Child Learn and Play (PDF)

Other Languages: Español |
Русский |
简体中文 |
Kreyòl ayisyen |
한국어 |
বাংলা |
العربية |
Français |
اردو

Clinicians' Guide: The Early Intervention Program in New York City (PDF)

Clinicians' Handout: Algorithms for Before and After Referral to Early Intervention (PDF)

If you have questions about the NYC EIP Policies and Procedures, email EITA@health.nyc.gov

More Information

Early Intervention: Information for Providers

Early Intervention: Professional Development and Trainings

Early Intervention: Family-Centered Best Practices

Early Intervention: Main Page