Los Niños Services is happy to provide the forms below to the Early Intervention community. To view a document, left click on it. To download a document, right-click on it and choose "Save As". Some documents are in PDF format. If you do not have Adobe Acrobat Reader (which allows you to view PDF files), you may obtain it free from: http://www.adobe.com/products/acrobat/readstep2.html.

New York City

Early Intervention Forms

• NYC EI Referral Form
• NYC EI Transportationl Form
• NYC Consent to Evaluate (Spanish)
• NYC Consent to Evaluate (English)
• NYC Consent for Release Info FROM LNS (Spanish)
• NYC Consent for Release Info FROM LNS (English)
• NYC Consent to Release Info TO LNS (Spanish)
• NYC Consent to Release Info TO LNS (English)
• NYC Reason for Delayed Submission of Evaluation (Spanish)
• NYC Reason for Delayed Submission of Evaluation (English)
• NYC Change in Frequency EI Form

Families As Partners (FAP)

• NYC FAP Calendar
• NYC FAP EI IFSP Form
• NYC FAP Session Notes
• Session Note Instructions
• Progress Note Instructions
• 3, 6, 9, 12 month Progress Notes
• Co-Visit Session Note Instructions
• Co-Visit Note
• Instructions for FAP Calendars

Regulations

• 07-01-03 Documents
  • REGS - NYC Dept_of_Health_and_Mental_Hygiene Requirement Change Letter (Dated 7_1_03)
  • REGS - NYC Dept_of_Health_and_Mental_Hygiene Revised to Improve Appicability to Local Needs Letter (Dated 7_1_03)
• 06-27-03 Documents
  • REGS - Evaluation Requirements under the Early Intervention Program (Revision 6_27_03)
  • REGS - Guide to Changes in EI Initiatives (Revised 6_27_03)
  • REGS - Recommended Evaluation Instruments (Revised 6_27_03)
• 06-13-03 Documents
  • REGS - Supervisory Consultation (Revised 6_13_03)
  • REGS - Implementation Schedule (Revised 6_13_03)

Other

• Families as Partners Presentation - September, 2005

New York State

Early Intervention Program Memoranda and Guidance

• Early Intervention Program Memoranda and Guidance
• Guidance Document on Transition of Children at Age Three Timeframes for Transition to Preschool Special Education Programs - February 25, 2004 Letter
• Amendments to Title 11-A of Article 25 of Public Health Law - July 31, 2003 Letter
• EI Continuing Eligibility Requirements - August 5, 2005

Regulations

• REGS - NYS Dept Of Health, Early Intervention Program, Memorandum 2005-02 

Westchester

Early Intervention Forms

• Westchester Annual IFSP Form
• Westchester Assignment of Benefits and Medical Release Info Form
• Westchester Consent to Evaluations
• Westchester Progress Reports
• Westchester Record of EI Services
• Westchester Sixth Month IFSP Form

Los Niños

Services Forms (available to LNS Staff only)

• LNS Agency Contact Notes
• LNS Annual Staff Health Form
• LNS Clinician Invoice
• Daily Attendance Log
• Simplifies LNS Services Sample Invoice