Early Intervention Providers  

                                                                           
                                                                    All forms are in pdf format

For New EI Providers (Applicants)

• Important notice to potential EI Applicants (Providers) 
• EI Application Packet 
• EI Program Procedure Guidelines for the EI Provider Certification Process

EI References and Resources

• EI Providers (4/2013)
• Coverage Areas for EI Providers (12/2012)
• EI Certification Standards (9/2005)
• EI State Rules and Regulations
• IFSP Documentation Guidebook

EI Forms and Applications

• Individual Family Service Plan (IFSP)
• Individual Family Service Plan (IFSP)- Spanish
• Child Outcomes Summary Form
• DCYF Case Status Form
• Request for Surrogate Parent Form
• EI Hearing Checklist
• EI Vision Checklist 
• MEC Codes
• Transition Plan
• Exit/Discharge Form
• Referral and Demographics Form
• Services Rendered Form
• Services Rendered Form-For Intake
• Services Rendered Form-With Prior Notice
• EI Materials Order Form
• Attestation of Income
• Attestation of Income (Spanish)
• EI Providers Self-Assessment Form
  

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