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Initial Visit/Screening

This is the first visit after the referral and prior to the evaluation/assessment visit. If applicable, the following documents and forms may be completed at the initial visit.  The initial visit is conducted within 10 business days of the date of the referral.

Documentation and forms used:

  • Interim IFSP: GCI-1021A-T

  • The IFSP meeting happens when there is a need to have services put in place for children who are eligible without having to start with the referral to initial IFSP process.

  • An example of when you would complete an interim IFSP is when a child NICU and the family/specialists requested to have services set up prior to the child being discharged from the hospital.

  • Consent for Screening-PWN (Prior Written Notice): GCI-1082A

  • A consent form must be completed prior to the family sharing any information about the child.

  • Ages and Stages Questionnaire (ASQ)

  • This is a screening tool that team members may used to gather information to determine whether to proceed with a evaluation.

  • Vision Screening Checklist: GCI-1085A

  • Every child must have an initial vision screening as part of the screening process.

  • If there are any indicators or concerns, the family is then referred to the child primary doctor.

  • Hearing Screening Tracking Form: GCI-1084A

  • This form is a tracking form and is used to record any activities completed for hearing screenings, evaluation, or tests. It is completed at initial and annual IFSP.

  • Consent for Evaluation/PWN: GCI-1038A

  • Used when an evaluation is recommended by the team or requested by the parent.

  • PWN (Refuse to evaluate, if applicable): GCI-1050A

  • Used when the team is not recommending an evaluation.

  • Consent to Obtain Information: GCI-1039A

  • Used to release and share information on a child, verbally and written

  • This information shared is relevant to other information that was not completed by AzEIP (ACT)

  • Authorization to Disclose Protected Health Information: GCI-1020A

  • Used to request medical records from another outside source

  • Consent to Share Early Intervention Records and Information: GCI-1040A

  • Used to share early intervention records, verbally and written

  • The information shared is relevant to the work completed by AzEIP (ACT), not outside evaluations

  • Consent for Insurance: GCI-1041A

  • Used for ongoing services

  • Completed after a child has been determined eligible

  • Must be completed by all families in early intervention who have public and/or private insurance.

  • Families have the option to consent to use or not use insurance.

  • Consent for Child Assessment: GCI-1083A

  • Used to obtain consent from the family to conduct the Child and Family Assessment.

  • Completed each time the C&F Assessment is completed.

  • Child and Family Assessment Guide for Families: GCI-1088A

  • Used to gather information about the child and family that supports the development of the IFSP.

  • Completed before or at the beginning of the initial IFSP meeting

  • Completed at the annual IFSP meetings

  • Child and Family Rights in AzEIP

  • Shared with the family throughout each process in early intervention.

  • AzEIP Child Data Form: GCI-1087A

  • Data form that is updated and entered in I-TEAMS, when applicable


Additional Resources:

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