NYS Early Intervention Program Assistive Technology Medical Necessity Justification Form 2026

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

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