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:
Forms
- Article 47 — Early Intervention Professionals in Child Care Settings
- 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)
Other Languages: Español | Русский | 简体中文 | Kreyòl ayisyen | 한국어 | বাংলা | العربية | Français | اردو | ਪੰਜਾਬੀ
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)
If you have questions about the NYC EIP Policies and Procedures, email EITA@health.nyc.gov