State Forms, Instruction Manuals, And Processes

• Child Health Plan Plus (CHP+) HMO Authorization Form NEW!
• Child Outcomes Summary Form (COSF)
• Declining Early Intervention Services Form NEW!
• Formal Dispute Resolution Request Form NEW!
• HIPAA and FERPA Compliant Consent to Share Information Form (Sample)
• Health Care Program for Children with Special Needs (HCP) Collaborative Guidelines
• Health Insurance Authorization Form NEW!
• Insurance Declination Form
• Individualized Family Service Plan (IFSP) Forms and Instruction Manual
• Notice and Consent for Screening Form (Draft) NEW!
• Referral Form NEW!
• Referral Status Update Form NEW!
• Special Education Administrative Unit/School District Notification Form NEW!
• Prior Written Notice Form (Draft) NEW!
• Prior Written Notice and Consent for Initial Evaluation and/or Assessment Form (Draft) NEW!

Community Contract and Management System (CCMSweb) Database Instructions and Early Intervention Billing Instructions
Early Intervention Evaluation Form NEW!
Early Intervention Services Revenue and Expenditure Report Template (revised 8/29/12)
Fiscal Management and Accountability Procedures (FMAP) NEW!
General Supervision & Monitoring Procedures 2012 NEW!
Guidelines for Infant Hearing Screening, Audiologic Assessment, and Early Intervention
Insurance Exemption Form NEW!
Payor of Last Resort Federal Part C Funds Request Form NEW!
Procedures for Referrals made by a Level III NICU (draft)
Trust Fund Transfer Form
Vision Screening Manual for Children Birth to Five Years of Age