Billing
1. EI Monthly Summary Services Billing Form.
2. Preschool-School Age RS Billing Form w Consult Session rev 6-2017
3. Preschool-SEIT-ABA Only
4. Preschool Attendance Form-Related Services & SEIT and Instructions
5. School Age Attendance Form-RSA-7A
6. Group Services
7. Evaluations-EI Billing Form
8. Evaluations-CPSE-CSE Billing Form rev Apr 2016
9. NYC EI CPT CODES
10. Commonly used CPT codes rev Sept 2015
11. NYC DOE SEIT Services Form & Instruc_rev 4-3-17
EI
1. Daily Log Note rev 9 2015
2. Daily Log Note Instructions rev 9 2015
3. Progress Report w Instructions_rev 8 2014
4. Parental Consent to Release Information rev 11-26-14
5. Authorization for Alternative Parental/Guardian/Caretaker Signature
6. Notification of Non-Delivery of Authorized Services
7. Justification for Change in Frequency, Intensity or Method
8. NYC EIP Family Activity Sheet with instructions
9. Prescription for Services rev Sept 2015.
10. Speech Referral for Evaluation and Recommendation for Services rev Sept 2015
11. Parent Consent To Use E-mail to Exchange Personally Identifiable Info
CPSE
Billing
CPSE CSE Evaluations Billing Form
Parental Consents
Authorization For Alternative Signature
Email Consent
Medical Parental Consent Form
Service Forms
Prescription Form Services
Notification Of Provision Of Mandated Services
Service Form With Directions
Verification Of Absence Makeup Form
Request For Change In Services
Notification For Last Attend Date
Policy & Procedure Handbook Revised
AAK Sign In Form
CPSE Reporting Information & Due Dates
SEIT ABA Quarterly Review Report Instructions
SEIT ABA Quarterly Review Progress Report Blank
SEIT ABA Quarterly Review Sample
Annual Review Progress Report Instructions
Annual Review Progress Report Blank SEIT
Annual Review Progress Report Related Services
Annual Review Progress Report Related Services Instructions
Annual Review Progress Report Related Services Template Blank
Meeting Outcome Form CPSE & CSE
CSE
1. Treatment Log-SEIT-SEIT ABA rev 1-20-17
2. CSE GROUP Service Treatment Log rev Aug 2015
3. Verification of Missed Session form
4. Progress Report Due Dates
5. CSE Quarterly Progress Note
6. NYC Dept of Ed IEP_10-1-2011
7. Notification of Extended Non-Delivery of SEIT/Related Services
8. Meeting Recommendation Form-Annual Review
9. Meeting Recommendation Form-Excluding Annual Review
10. Interactive Voice Response System-Calling In the 1st Attend Date
11. Prescription for Services 2015-2016 School Year
12. Speech Referral for Evaluation and Recommendation for Services rev Sept 2015
13. Prescription for Evaluations rev Sept 2015
14. Psychological Counseling Referral for Evaluation and Services 2015-2016
15. Parent Consent To Use E-mail to Exchange Personally Identifiable Info
Evaluations – EI
1. Consent for Evaluation and Screening
2. Consent to Obtain Physical
3. Consent to Release Information to Pediatrician
4. Speech Referral for Evaluation and Recommendation for Services rev Sept 2015
5. Parent Informing Form
6. Meeting Form
7. Parental Waiver of Bilingual Evaluation Summary
8. MDE Summary Format & Instructions
9. Prescription for Evaluations rev Sept 2015
Evaluations – CPSE
1. Home Language Survey
2. Student Evaluation Summary
3. Consent to Obtain Physical
4. Consent to Release Information to Pediatrician
5. Classroom Observation Form
6. Child Outcome Summary Form
7. NYC Dept of Ed IEP 10-1-2011
8. Speech Referral for Evaluation and Recommendation for Services rev Sept 2015
9. Parent Informing Form
10. Meeting Form
11. Psychological Counseling Referral for Preschool Evaluation & Services 2015-2016
12. Prescription for Evaluations rev Sept 2015
Therapists
1. NPI-Memo
2. NYS Central Registry Form_Rev Apr 2011
3. Medical Form rev Jul 2014
4. Release to Receive EI Services from a DOE Employee