Provider Forms

(Nassau / Suffolk / NYC)
E a r l y I n t e r v e n t i o n			CPSE			CSE
Nassau	NYC	Suffolk	Nassau		Suffolk
EI Treatment Log	Directions for Completing NYC Session Notes NYC FAP Calendar NYC Co-visit Session Note NYC Session Note	EI Treatment Log	Monthly Service Calendars: RS-SEIT Summer Calendar 2010 RS-SEIT Calendar 2010-2011 RS-SEIT Summer Calendar 2011 (Rev. 8/29/10) CPSE RS Treatment Log (Rev. 8/30/10) RS Treatment Log Guidance Document (Rev. 8/30/10) CPSE SEIT Treatment Log (Rev. 8/30/10) SEIT Treatment Log Guidance Document (Rev. 8/30/10)		CPSE/SEIT Treatment Log CPSE/SEIT Treatment Log Instructions CPSE Related Service Log (Rev. 8/3110) CPSE Related Service Log Directions (Rev. 8/31/10)	CSE Treatment Log Roslyn S.D. Manhasset S.D. Syosset S.D.
(Nassau / Suffolk / NYC)
Nassau				NYC
Bilingual Evaluation Justification (English & Spanish) Evaluation Consent Form Forma Del Consentimiento Family Assessment Speech Recommendation Meeting Results Prescription Release Form				Evaluation Consent Form Delay Form Obtain/Release Form Evaluation Representative Signature Page MKS&A NYC Evaluation Representative Form
Suffolk Bilingual Evaluation Evaluation Consent Form Forma Del Consentimiento Family Assessment Speech Recommendation Meeting Results Prescription Release Form
(Nassau / Suffolk / NYC)
Nassau				NYC
Notification of Non-Delivery of Authorized Svcs.3 EI/CPSE Team Meeting Suggestions & Questions 4 Authorization for Alternative Signature (Rev. 8/30/10) Child Absence Notification Special Education Itinerant Teacher (SEIT) Absence Note Meeting Results Incident Report				Authorization for Alternative Signature Child Absence Notification Form Speech Recommendation Form
Suffolk
EI-Notification of Extended Non-Delivery of Services 18 Team Meeting Results 19 EI Review Request 21 Authorization for Alternative Signature Verification of Absence and Make-up Session Meeting Results Incident Report Non-Delivery of Service Alternative Signature Form

2009/2010 Calendar of Days of Operation for Daily Instruction 2010/2011 Calendar of Days of Operation for Daily Instruction

Statewide Central Register Database Check Form Annual Medical Exam Form Decline Immunization Form

CPT Codes ICD-9 Codes