DOH EI Treatment log Daily Notes 2026

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  1. Click ‘Get Form’ to open the DOH EI Treatment log Daily Notes in the editor.
  2. Begin by entering the child's name and date of birth in the designated fields. Ensure that you print legibly using black ink for clarity.
  3. Fill in the service type and authorized sessions, along with the provider/agency name and authorization number. This information is crucial for tracking services provided.
  4. For each session, record the date, attendance status (C= Clinician cancelled, P= Parent cancelled, etc.), and session content. Be sure to include desired outcomes/goals and CPT codes as applicable.
  5. After completing each section, ensure that both the parent/caregiver and provider sign where indicated. This confirms attendance and agreement on session details.
  6. Finally, complete any recommendations for support or guidance for parents at the end of the form to provide additional context.

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Families, doctors, and community members can make a referral by: Calling 311 and asking for Early Intervention.
The goal of the Early Intervention Program is to help families help their children learn and develop. If your child is eligible for the program, we will assign a team to your child that will include teachers, therapists, a service coordinator and an Early Intervention Official Designee.
How to Apply for Approval as an Early Intervention Agency: To obtain approval, the applicant must submit a completed Agency Application/Provider Agreement, including all required schedules and attachments, to the New York State Department of Health (Department).

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Parents are encouraged to call 311 and ask for Early Intervention to make referrals. Administration for Childrens Services (ACS) employees and agencies contracted with ACS must call the Citywide ACS Referral Hotline at 877-885-KIDZ (877-885-5439) to make referrals.
To provide Early Intervention services in New York City, you must have a Provider Agreement with the NYS Department of Health to provide service coordination, evaluation or services. You may provide Early Intervention services in a familys home or community, or in a facility, as approved by the State.
To be eligible for services, children must be under 3 years of age and have a confirmed disability or established developmental delay, as defined by the State, in one or more of the following areas of development: physical, cognitive, communication, social-emotional, and/or adaptive.
In New York City, children with developmental delays and disabilities under three may receive these supports through Early Intervention (EI), run by the Department of Health and Mental Hygiene (DOHMH).
Early intervention means identifying and providing effective early support to children and young people who are at risk of poor outcomes. Effective early intervention works to prevent problems occurring, or to tackle them head-on when they do, before problems get worse.

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