Early Intervention Provider Toolkit

For Early Intervention Providers

• UF NCES Provider Manual, 2020
• UF NCES Provider MOA, 2020-21
• Provider Meeting Presentation
• UF NCES – Demonstration Site
• UF NCES – IFSP Form
• UF NCES Provider List
• Exhibit A – Service Initiation Form
• Exhibit B – Monthly Progress Note
• Exhibit C – Discharge Summary Form
• Exhibit D – Procedural Safeguard
• Exhibit E – Statement of Understanding
• Exhibit F – Service Fee Schedule
• Exhibit G – El Claims Form

• Exhibit G – Therapy Claims From
• Exhibit H – In-State Travel Form – Community Providers
• Exhibit H – In-State Travel Form – Example Only
• Exhibit I – Consultation Form
• Exhibit J – Homeland Security Statement
• Exhibit K – MMA Plan Enrollment Summary
• Exhibit L – TPIN Plan Enrollment Summary
• AT Activity Based Assessment
• AT Request
• AT Receipt Form
• Plan of Care

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For Interpreters

• UF NCES Interpreter MOA, 2020
• Business Associate Agreement, 2020-21
• Exhibit A – Procedural Safeguards
• Exhibit B – Statement of Understanding
• Exhibit C – Homeland Security Statement
• Exhibit D – Interpreter Claims Form
• Exhibit E – In-Sate Travel From