Forms

Purpose: To notify the administrative unit of a child who is potentially eligible for Part B services Form:

Purpose: To share information to/from EI Colorado to another agency or entity Form

Purpose: Consent for a child to remain enrolled in Early Intervention after their third birthday and delay the start of Part B services Form:

Purpose To provide prior written notice and obtain consent for the initial evaluation or assessment. Used when confidential information may be on the EI Referral Case Form

Purpose To decline participation in early intervention at the time of evaluation, IFSP development, or services Form

Purpose Allows parent/guardian to decline one or more services listed on the IFSP Form

Purpose Provides consent to bill private insurance, serves as consent to share information with public or private insurance company Form

Purpose Allows parent/guardian to decline use of private insurance Form

Purpose To provide timely written notice before a change is proposed or refused in the identification, evaluation or placement of a child, or the provision of EI services Form

Purpose To provide prior written notice and obtain consent for the initial evaluation or assessment Form

Purpose Consent for any recording made during service delivery shall not be shared by any participants Form

Form Enter EI Services Enter IFSP Team Members All IFSP Team Members will sign IFSP NOTE: Parent/Guardian should not be listed as IFSP Team Member