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    Templates for All DocuSign Forms
    • 11 Jun 2025
    • 4 Minutes to read
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    Contents

    Templates for All DocuSign Forms

    • Updated on 11 Jun 2025
    • 4 Minutes to read
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    Article summary

    Purpose

    This guide contains instructions and procedures to utilize DocuSign in the EI Colorado Provider Portal and Data System. If users have questions or need assistance, please complete the EI Data System Bug and Suggestions form.

    Note: It is important to consolidate forms into one envelope when possible. Each sent envelope has a fixed cost.

    To view a list of the emails sent to the contact listed as “DocuSign Recipient #1” view the DocuSign: Form and Combination Emails 1 of 2 and DocuSign: Form and Combination Emails 2 of 2 documents.

    Forms

    • Administrative Unit Notification

      • Purpose: To notify the administrative unit (school district/BOCES) of a child who is potentially eligible for Part B services

      • Parent/Guardian can provide consent to share information ahead of the 10-day timeline, or can opt-out of notification

      • Short Name: AU

      • Sent to: DocuSign Recipient #1

    • Authorization to Release Information

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

      • Short Name: ROI

      • Sent to: Service Coordinator to complete, then sent to DocuSign Recipient #1

    • Consent for Extended Part C Option

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

      • Short Name: Extended Part C

      • Sent to: DocuSign Recipient #1

    • Confidential: Consent to Eval

      • 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

      • Short Name: Consent to Eval

      • Sent to: Service Coordinator to complete, then sent to DocuSign Recipient #1

      • Information is pulled from the scheduled evaluation appointment. The Service Coordinator can redact meeting location details as needed for confidentiality  

    • Declining Participation in Early Intervention

      • Purpose: To decline participation in early intervention at the time of  evaluation, IFSP development, or Services

      • Sent to: DocuSign Recipient #1, then Service Coordinator

    • Declining Services

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

      • Short Name: Decl C

      • Sent to: Service Coordinator to complete, then sent to DocuSign Recipient #1

    • Health Insurance Authorization

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

      • Short Name: HIA

      • Sent to: Service Coordinator to complete, then sent to DocuSign Recipient #1

    • Insurance Declination

      • Purpose: Allows parent/guardian to decline use of private insurance

      • Short Name: Ins Decl

      • Sent to: Service Coordinator to complete, then sent to DocuSign Recipient #1

    • Prior Written Notice

      • 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

      • Short Name: PWN

      • Sent to: Service Coordinator to complete, then sent to DocuSign Recipient #1

    • PWN and Consent for Initial Evaluation/Assessment

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

      • Short Name: Consent to Eval

      • Sent to: DocuSign Recipient #1

      • Information is pulled from the scheduled evaluation appointment  

    • Telehealth Recording Statement

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

      • Short Name: Telehealth

      • Sent to: DocuSign Recipient #1

    • Individualized Family Service Plan

      • Short Name: IFSP

      • Sent to: IFSP Participants, then sent to DocuSign Recipient #1

    Form Combinations

    • Administrative Unit | 2 ROI

      • Forms sent to Service Coordinator to complete, then to DocuSign Recipient #1

    • Combination 2 ROIs

      • Forms sent to Service Coordinator to complete, then to DocuSign Recipient #1

    • Consent for Eval | PWN

      • Forms sent to Service Coordinator to complete, then to DocuSign Recipient #1

    • Consent to Eval | 2 ROI

      • Forms sent to Service Coordinator to complete, then to DocuSign Recipient #1

        • Confidential: Consent to Eval | 2 ROI

          • Service Coordinator can redact meeting location details as needed for confidentiality

    • Consent to Eval | ROI

      • Forms sent to Service Coordinator to complete, then to DocuSign Recipient #1

        • Confidential: Consent to Eval | ROI

          • Service Coordinator can redact meeting location details as needed for confidentiality

    • Est. Cond: PWN | Consent for Initial Assessment

      • Purpose: To provide prior written notice and obtain consent for the initial assessment and the initial IFSP for a child with an established condition

      • Form is sent to Service Coordinator and then sent to DocuSign Recipient #1

      • Information is manually entered by SC

    • HIA | 2 ROI

      • Forms sent to Service Coordinator to complete, then to DocuSign Recipient #1

    • HIA | AU

      • Forms sent to Service Coordinator to complete, then to DocuSign Recipient #1

    • HIA | AU | 2 ROI

      • Forms sent to Service Coordinator to complete, then to DocuSign Recipient #1

    • HIA | Telehealth

      • Forms sent to Service Coordinator to complete, then to DocuSign Recipient #1

    • HIA | Telehealth | AU

      • Forms sent to Service Coordinator to complete, then to DocuSign Recipient #1

    • HIA | Telehealth | AU | 2 ROI

      • Forms sent to Service Coordinator to complete, then to DocuSign Recipient #1

    • HIA | Telehealth | Decl Services

      • Forms sent to Service Coordinator to complete, then to DocuSign Recipient #1

    • HIA | Telehealth | Decl Services | AU

      • Forms sent to Service Coordinator to complete, then to DocuSign Recipient #1

    • HIA | Telehealth | Decl Services | AU | 2 ROI

      • Forms sent to Service Coordinator to complete, then to DocuSign Recipient #1

    • Ins Decl | 2 ROI

      • Forms sent to Service Coordinator to complete, then to DocuSign Recipient #1

    • Ins Decl | AU

      • Forms sent to Service Coordinator to complete, then to DocuSign Recipient #1

    • Ins Decl | AU | 2 ROI

      • Forms sent to Service Coordinator to complete, then to DocuSign Recipient #1

    • Ins Decl | Telehealth

      • Forms sent to Service Coordinator to complete, then to DocuSign Recipient #1

    • Ins Decl | Telehealth | AU

      • Forms sent to Service Coordinator to complete, then to DocuSign Recipient #1

    • Ins Decl | Telehealth | AU | 2 ROI

      • Forms sent to Service Coordinator to complete, then to DocuSign Recipient #1

    • Ins Decl | Telehealth | Decl Services

      • Forms sent to Service Coordinator to complete, then to DocuSign Recipient #1

    • Ins Decl | Telehealth | Decl Services | AU

      • Forms sent to Service Coordinator to complete, then to DocuSign Recipient #1

    • Ins Decl | Telehealth | Decl Services | AU | 2 ROI

      • Forms sent to Service Coordinator to complete, then to DocuSign Recipient #1

    For questions, content edits, or other inquires on this document contact the EI Data Team.

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