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How to use or fill out NYS Early Intervention Program Assistive Technology Medical Necessity Justification Form with DocHub
- Click ‘Get Form’ to open the NYS Early Intervention Program Assistive Technology Medical Necessity Justification Form in our platform.
- Begin by filling in the child's name, date of birth, and EI number at the top of the form. Ensure all identifying information matches official records.
- In the 'Service Type' and 'Service Location' sections, specify the type of service being rendered and where it will take place.
- Document the child's diagnosed conditions along with corresponding ICD-9 codes. This is crucial for proper authorization.
- Contact your regional TRAID Center or Municipality Lending Closet to determine device availability. Record this information in question 1, including dates and outcomes.
- For each requested ATD category/device, provide justifications for its necessity in enhancing the child’s functional skills in section 2.
- Complete sections detailing how the ATD will integrate into daily routines and address any precautions related to the child's condition.
- Finally, ensure both parent/caregiver and Individual Rendering Provider sign the form before submission to maintain compliance with requirements.
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