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STEP 1:
Contact your System Point of Entry (SPOE) office to discuss your concern about your child. This is called a referral and starts a 45 calendar day timeline for the system.
_____________________ Date of Referral – If determined eligible, your child’s Individualized Family Service Plan should be complete 45 days from this date.
An intake appointment is set up at a mutually convenient time and place to:
_____________________ Date, Time, and Location of Intake Meeting
_____________________ Name and Contact Information of Intake Coordinator
Appointments are scheduled for the Eligibility Determination Team (ED Team) to conduct assessment activities to provide more information for the Eligibility Determination Meeting (see Step 4)
_____________________ Assessment Date, Time, and Location
Your Intake Coordinator will contact you and the other team members to set up meetings at mutually convenient times and places to
You should receive 10-Day Prior Written Notice confirming times, locations, and attendees of these meetings, along with a copy of your child’s Assessment Summary Report.
__________ Date of Eligibility Determination Meeting
__________ Date of IFSP Meeting – may be the same day as Eligibility Meeting [Must be held within 45 days of referral (by date of ___________)]
Who Should Attend these meetings?
IFSP Meeting is completed and Ongoing Service Coordination of the Plan begins
___________________ Name and Contact Info of FS Service Coordinator
___________________ Name of Provider __________________ Specialty
___________________ Name of Provider __________________ Specialty
___________________ Name of Provider __________________ Specialty
Signature from Physician on IFSP agreeing with services is required before ongoing services can begin (Required within 10 days from IFSP date – Service Coordinator sends materials to physician and follows up)
___________________ Date Physician Signature Required
___________________ Date Physician Signature actually signed and returned to SPOE
Ongoing services can begin [All services should begin within 30 days of IFSP (date ________)]
___________________ Service ___________________ Date Began
___________________ Service ___________________ Date Began
___________________ Service ___________________ Date Began
*LOOKING TO THE FUTURE: Families can ask for an evaluation of their IFSP at any time, but evaluations must occur at least every six months.
_________________ Date by which first 6-Month Review must occur (repeats each year in First Steps)
_________________ Date (one year minus one day after previous IFSP meeting) by which first Annual IFSP
Meeting must occur (repeats each year in First Steps) - Eligibility must be re-determined at Annual Meetings
Who Should Attend 6-Month Reviews and Annual IFSP Meetings?
_________________ Date by which Transition Meeting for transition out of First Steps at age 3 must occur if still receiving services in FS (Transition meeting must occur at least 90 days prior to the child’s third birthday, but may occur as early as 270 days before)
Who Should Attend?
* No cost to family for this service
**Invited guests may include
** ** Possible co-pay for services up to a monthly maximum on a sliding scale based on family income, family size, medical expenses, insurance coverage, and extenuating circumstances (speak to Service Coordinator to determine family co-pays)