Company Forms

                File Name

 Type Size
Addendum to Contracts - Twice a Month Billing / 60 Day Requirements                   DOC 99 K
New Twice a Month Billing Requirement / Letter to Providers about 60 Day Time Reduction    DOC 30 Kb.
       
Letter to Providers ( OT and PT ) about the use of ICD-Codes on Session Notes                                              DOC 35 Kb.
Letter to Providers ( Speech ) about the use of ICD-Codes on Session Notes                                                             DOC 38 Kb.
       
Session Note   (Help)                                            DOC 33 Kb.
Session Note CO-VISIT  (Help)                       DOC 32 Kb.
ABA Session Note                                              DOC 35 Kb.
ABA Session Note CO-VISIT                               DOC 31 Kb.
       
       
Consent For Evaluation And Screening                     DOC 37 Kb.
Consent To Release Obtain Information                   DOC 41 Kb.
Summary Of Multidisciplinary Evaluation MDE         DOC 67 Kb.
       
  Assessment Of Safety Setting For Provision EI Services PDF 30 Mb.
       
CPG Compliance Plan                                                    DOC 99 Kb.
New Requirements For BOE Employees                         DOC 30 Kb.
DOE Employee Conflict Of Interest Policy                       DOC 74 Kb.
Notification To DOHMH Of DOE Employee Working For EI Agency                                                                   DOC 38 Kb.
Parent Release Fo DOE Employee To Provide EI Services                                                                 DOC 33 Kb.
       
  Policy And Procedures On Service Delivery           PDF 95 Kb.
  Policy And Procedure On Service Delivery Table   PDF 30 Mb.
       
Progress Report                                 DOC 186 Kb.
Progress Report ABA                         DOC 187 Kb.
Progress Report ABA Team Meeting DOC 188 Kb.
Instructions For Completion Progress Notes  DOC 619 Kb.
Justification Letter ( Change in Service )  DOC 481 Kb.
Justification Letter ( HELP ) DOC 481 Kb.
       
  NYC EI Provider Agreement                        PDF 3.4 Mb.
  State Central Register Database Check       DOC 41 Kb.
       
QA About Daily Session Notes        DOC 37 Kb.
       
       
NYC DOHMH Crosswalk of ICD-9 and CPT        DOC 81 Kb.
NEW CPT ICD9 Codes  04 15 2011                                   XLS 91 Kb.
CPT Guidance And Recommendations                           DOC 28 Kb.
       
NYC EI ICD9 Codes OLD                                 PDF 281 Kb.
ABSENCE NOTE DOC 35 Kb.
       
FAP Parent / Caregiver Calendar (Help 1)(Help 2) PDF 19 Kb.
Attestation Page DOC 21Kb.
Justification Letter For Evaluation DOC 20 Kb
Invoice  (Print in Landscape Mode) DOC 68 Kb.
Direct Deposit  DOC 32 Kb.
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