Early Intervention: Provider Policies, Procedures and Forms
Procedures
- Guidance on Health Home Implementation in the New York City Early Intervention Program (PDF)
- NYC EI Policy and Procedure Manual (PDF)
- Self-Assessment Tool for New York City EIP Providers (PDF)
- Citations for Self-Assessment Tool:
Forms
- Steps Taken to Determine Need for Surrogate Parent (PDF)
- Request for Foster Care Surrogacy Determination Letter (PDF)
- Foster Care Surrogacy Recommendation and EIOD Assignment (PDF)
- Parent Designation of Person Acting in Place of Parent (PDF)
- Reassignment or Termination of Surrogacy (PDF)
- Initial Service Coordination Consents (PDF)
- Consent to Obtain and Release Information (PDF)
- Family Concerns, Priorities, and Resources (PDF)
- Reason for Delay in Evaluation Completion and MDE Submission (PDF)
- Request for Sign Language Interpreter (PDF)
- Initial Service Coordination Duration, Unit or Assignment Change (PDF)
- Consent for Evaluation or Screening (PDF)
- Screening Summary (PDF)
- Multidisciplinary Evaluation Summary (PDF)
- Evaluation Agency MDE and Screening Submission Checklist (PDF)
- Article 47 — Early Intervention Professionals in Child Care Settings
- Your Family Rights in Early Intervention (PDF)
Other Languages: Español | Русский | Français | বাংলা | 简体中文 | العربية | Kreyòl ayisyen | 한국어 | اردو | ਪੰਜਾਬੀ - IFSP Scheduling Forms — Manhattan (Fillable PDF)
- IFSP Scheduling Forms — Brooklyn (Fillable PDF)
- IFSP Scheduling Forms — Bronx (Fillable PDF)
- IFSP Scheduling Forms — Queens (Fillable PDF)
- IFSP Scheduling Forms — Staten Island (Fillable PDF)
- NYCEIP AT Medical Necessity Justification Form with Instructions (Fillable PDF)
- Session Note Version 1 (Fillable PDF)
- Session Note Version 2 (Fillable PDF)
- Group Session Note Version 1 (Fillable PDF)
- Group Session Note Version 2 (Fillable PDF)
- Service Log (Fillable PDF)
- Progress Note (Fillable PDF)
- IFSP Packet for Printing (PDF)
- CH205 (Child & Adolescent Health Examination Form) (PDF)
- Early Intervention Referral Form (PDF)
- Functional Outcomes Assistant and Instructions (PDF)
- Status of Start Date of Services (Fillable PDF)
- Closure Form (Fillable PDF)
- Change in Service, Service Provider, Service Coordinator (Fillable PDF)
- Early Intervention Program Mileage Reimbursement Form (Fillable PDF)
- Parent Consent for Public Transportation or Mileage Reimbursement (PDF)
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 | Français | Русский | বাংলা | 简体中文 | العربية | Kreyòl ayisyen | 한국어 | اردو - Clinicians' Guide: The Early Intervention Program in New York City (PDF)
If you have questions about the NYC EIP Policies and Procedures, email EITA@health.nyc.gov