NYC Early Intervention Assistive Technology Medical Necessity Form 2026

1. Click ‘Get Form’ to open the NYC Early Intervention Program Assistive Technology Medical Necessity Justification Form in the editor.
2. Begin by entering the child's name, date of birth, and EI number at the top of the form. Ensure all identifying information matches what is recorded in NYEIS.
3. Fill in the service type and location, along with the child’s diagnosed conditions and corresponding ICD-10 codes.
4. Complete the section for the Individual Rendering Provider’s name and credentials. Indicate if the child can travel to a vendor location.
5. Document your communication with the TRAID Center regarding device availability, including dates and outcomes.
6. Proceed to justify each requested assistive technology device (ATD) category and its accessories based on how they will support the child's functional skills.
7. Describe how the ATD will be integrated into daily routines, ensuring it meets both developmental needs and family priorities.
8. Finally, ensure both parent/caregiver and provider signatures are included before submitting the completed form.

Start filling out your form online for free today!