General Documents

• EIP Referral Form: (English | Instructions)

• Family Rights in Early Intervention  Español | Русский | Français | বাংলা | 简体中文 | العربية | Kreyòl ayisyen | 한국어 | اردو | ਪੰਜਾਬੀ

• NYC Early Intervention Policy and Procedure Manual

• Assistive Technology Specification Form

 

Professionals

Initial Service Coordination

• EIP A Parent’s Guide: Chinese | English | Spanish | Korean

• Initial Service Coordination Package​

  • Parental Consent to Release/Obtain Information | Spanish (Read-Only)

  • Parental Consent to Initiate Service Coordination | Spanish (Read-Only)

  • Parental Consent to Use E-mail to Exchange Personally Identifiable Information 

  • Insurance Toolkit (Fillable PDF)

  • Child Insurance Information - Form B, Instructions, Parent Notice Regarding Insurance and Authorization To Release Health Insurance Information – Form C (non-English versions): Korean, Chinese, Spanish, Bengali

  • OHIS Referral form

  • Transition Toolkit(CPSE)

  • TRANSITION INFORMATION FOR PARENTS

  • EIP to 4410 Calculator

  • Child Information Change Form

  • Reason for Delay of Evaluation

  • CPR/Routine activities worksheet

  • Notice of IFSP meeting

  • IFSP Packet for Printing (PDF)​

  • Make-up Policy

  • Child & Adolescent Health Examination Form

  • Closure Form

• Request for Additional Time/Units for Initial Service Coordination (Bronx Only)

• IFSP Scheduling Forms — Manhattan (Fillable PDF)

• IFSP Scheduling Forms — Brooklyn (Fillable PDF)

• IFSP Scheduling Forms — Bronx (Fillable PDF)

• IFSP Scheduling Forms — Queens (Fillable PDF)

Ongoing Service Coordination

• Request for Prescription for Services

• Status of Start Date of Services (Fillable PDF)

• Request for Additional Evaluation

• Change in Service, Service Provider, Service Coordinator (Fillable PDF)

• Parental Consent to Release/Obtain Information | Spanish (Read-Only)

• Parental Consent to Use E-mail to Exchange Personally Identifiable Information 

• Child Information Change Form

• Transportation Consent Form and Justification

• Parent Consent for Public Transportation or Mileage Reimbursement (PDF)

• Closure Form

• DTS Log in​

Foster Care Documents

• Foster Care Package

  • Steps Taken to Determine Need for Surrogate Parent for Children in Foster Care

  • Foster Care Letter Part I

  • Foster Care Letter Part II

  • Surrogate Parent Designation by Parent | Spanish (Read-Only)

  • Assignment or Termination of Surrogacy by EIOD

Other Documents​

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

• Session Note Version 1 (Fillable PDF)

• Session Note Version 2 (Fillable PDF)

• Progress Note (Fillable PDF)

• Progress Note (Word)

• Justification for Change in Frequency and Method (Word)

• Justification for Additional Evaluation

​

COVID-19 Guidance and Forms

• Consent to Initiate or Resume In-Person Services During COVID-19 

• NYC Service Log

• Checklist for Telehealth for COVID-19

• CONSENT FOR THE USE OF TELEHEALTH DURING COVID-19

• New York State Department of Health Bureau of Early Intervention Guidance to Early Intervention Providers Regarding Novel Coronavirus (COVID-19) – Revised 04.01.2020 (PDF)

• NYS Early Intervention Program Consent For The Use Of Telehealth During Declared State of Emergency For COVID-19 – Revised 04.01.2020 (PDF)

• Frequently Asked Questions Related to Virtual Early Intervention Visits During COVID-19 Declared State of Emergency (Questions 1-22) – Revised 04.01.2020 (PDF)

• Frequently Asked Questions Related to Virtual Early Intervention Visits During COVID-19 Declared State of Emergency (Questions 23-37) – New 04.01.2020 (PDF)

• Frequently Asked Questions Related to Virtual Early Intervention Visits During COVID-19 Declared State of Emergency (Questions 38-57) – Revised 06.29.2020 (PDF)

• NYS DOH Reopening New York: Resuming In-Person Early Intervention Program Services (PDF)

• NYS DOH Early Intervention Program Update: Home and Community-Based Services Regarding COVID-19 (PDF)

 

State-Sponsored Trainings

• New York State Early Intervention Program Online Professional Development Center

• How to Use the New York City Bureau of Early Intervention Learning Management System (LMS)