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Liam Smith

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Case Timeline

Referral Date December 22, 2025
45-Day IFSP Deadline February 05, 2026 45 days remaining
Child's 3rd Birthday July 22, 2026 (212 days)
Service Authorization Expires February 20, 2026 (60 days)

Info

Status:

EI#: EI-2024-002

Child Details

Date of Birth: July 22, 2023

Age: 2 years old

Gender: Male

EI Number: EI-2024-002

EIOD Name: Dr. Sarah Mitchell

Service Location: Home/Community

Caregivers & Contact

Caregiver 1: Sarah Smith

Caregiver 2: -

Email: sarah.smith@email.com

Phone: (555) 234-5678

Address

456 Oak Ave, Springfield, IL, 62702

County: Sangamon

Languages

English

Assignments

Team Assignment

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Agency: Default Agency

ISC: Not assigned

Agency Accepted: Pending
ISC Accepted: Pending

Service Authorization

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Start Date: 12/22/2025

End Date: 02/20/2026

Therapist: Not assigned

Accepted: Pending

Phase 1 - Referral Acceptance and Case Initialization

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This phase involves the initial processing of a child's referral by the Citywide Early Intervention Referral Unit (CEIRU), the creation of the required Initial Service Coordinator (ISC) Service Authorization, and the assignment and acceptance of the case by the ISC agency and individual coordinator. The primary objective of this phase is to initiate the case file within the electronic system and officially assign a service coordinator to promptly arrange contact with the parent to begin the Early Intervention (EI) process.

Case Initialization

Document Responsible Status Link Actions
ISC Service Authorization (SA) Official service authorization in EI-Hub establishing the ISC service period ... CEIRU Not Ready No link Edit
ISC Teams Assignment Internal assignment record in EI-Hub designating the assigned ISC Agency and ... SC Supervisor Not Ready No link Edit

Primary Input Document

Document Responsible Status Link Actions
NYC Early Intervention Program Referral Form Contains the child's demographic information, date of referral, category of s... Primary Referral Source Not Ready No link Edit

Welcome Packet

Document Responsible Status Link Actions
FAQ for Parents Regarding Eligibility and Resources Frequently asked questions document for parents. CEIRU Not Ready No link Edit
Telehealth in the Early Intervention Program Information about telehealth services available in EI. CEIRU Not Ready No link Edit
Welcome Letter for Parents Formal introduction letter to the assigned SC sent to the parent. CEIRU Not Ready No link Edit
What Does Everyone Do in Early Intervention? Guide explaining roles and responsibilities in EI. CEIRU Not Ready No link Edit
Your Family Rights in Early Intervention Document explaining family rights in the Early Intervention program. CEIRU Not Ready No link Edit

Phase 2: Initial Contact & Consents

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This phase requires the Initial Service Coordinator (ISC) to promptly contact the parent/caregiver and conduct a meeting to explain the Early Intervention Program (EIP) and family rights, while obtaining all necessary parental consents and collecting insurance information to enable the start of the evaluation process. The goal is to set the foundation for the child's Multidisciplinary Evaluation (MDE) and the subsequent Individualized Family Service Plan (IFSP) meeting, which must be convened within 45 days of the initial referral.
Initial contact due Dec 24 (Pending) Initial meeting due Dec 29 (Pending) 45-day IFSP: Feb 05

Contact attempts & meetings

Track outreach and billable time; daily totals update automatically.

No contact attempts logged yet.

Consents & required info

Capture mandated consents, CPR, insurance, and education dates.

Documents (Phase 2)

Conditional

Document Responsible Status Link Actions
Parental Consent to Use Email for PII Consent if parent wants PII exchanged via email. ISC Not Ready No link Edit

Foster Care (Conditional)

Document Responsible Status Link Actions
Request for Foster Care Surrogacy Determination Letter Letter sent to Foster Care Agency/Education Liaison to initiate surrogacy det... ISC Not Ready No link Edit
Steps Taken to Determine Need for Surrogate Parent (Foster Care) Internal record of steps taken to determine surrogate need. ISC Not Ready No link Edit

Insurance

Document Responsible Status Link Actions
Copies of Insurance Cards (Front/Back) Copies of all primary and secondary insurance cards. ISC Not Ready No link Edit
Health Insurance Toolkit Form A: Collection of Health Insurance Information Collects primary/secondary insurance details including Medicaid status. ISC Not Ready No link Edit
Health Insurance Toolkit Item 6/Form C: Parent Authorization to Release Health Insurance Information Authorizes release of health insurance information. ISC Not Ready No link Edit

Insurance (If Applicable)

Document Responsible Status Link Actions
Health Insurance Toolkit Form B: Parent Attestation of No Insurance Used only when family attests to no insurance/Medicaid. ISC Not Ready No link Edit

Mandatory Consents

Document Responsible Status Link Actions
Consent to Obtain and Release Information Form Authorizes release to Evaluation Site and other relevant caregivers/case mana... ISC Not Ready No link Edit
Family Concerns, Priorities, and Resources (CPR) Form Completed with parent to capture concerns, priorities, resources, and routines. ISC Not Ready No link Edit
Initial Service Coordination Consents Form Consent for SC activities, optional share MDE/IFSP with HCP, and admin text u... ISC Not Ready No link Edit

Phase 3: Foster Care & Surrogacy

Not Applicable
Not Applicable
This is a conditional flow that is triggered when a child is identified as being involved with the Administration for Children's Services (ACS), requiring the Initial Service Coordinator (ISC) to consult with the Foster Care Agency to promptly determine who has the legal authority to make Early Intervention (EI) decisions. The critical objective is to determine the availability of the child's birth parent and, if necessary, secure the Early Intervention Official Designee's (EIOD) appointment of a surrogate parent so that the evaluation process can proceed.

Phase 4: Evaluation Coordination and Authorization

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Consent due: Dec 27 (5 business days from referral) Evaluation due: Jan 21 (30 days from referral)
The primary goal of this phase is to authorize the Multidisciplinary Evaluation (MDE) or Screening, ensuring all legal consents and foundational documents are digitally submitted within required timelines, allowing the evaluation to commence.

Evaluator Selection & MDE Setup

Select evaluation agency, program type, and document any telehealth justifications.

Authorization Tracking

Track consent receipt, SA creation, and SA acceptance.

Consent for Evaluation Received: Pending
Telehealth Consent Received: N/A or Pending
MDE Service Authorization Created: Pending
Evaluation Agency Accepted SA: Pending
Prescription for PT/OT/Nursing Obtained: N/A or Pending

Documents (Phase 4)

Authorization

Document Responsible Status Link Actions
MDE/Screening Service Authorization (SA) Service Authorization created within 2 business days of receiving signed Cons... ISC Not Ready No link Edit

Consent Receipt

Document Responsible Status Link Actions
Consent for Evaluation and Screening Form Consent received from Evaluation Agency (within 5 business days of referral). Eval Agency Not Ready No link Edit
Consent for Telehealth Form Telehealth consent if applicable, received from Evaluation Agency. Eval Agency Not Ready No link Edit

Post-Authorization

Document Responsible Status Link Actions
Evaluation Agency SA Acceptance Confirmation Confirmation that Evaluation Agency accepted the SA in EI-Hub. Eval Agency Not Ready No link Edit
Prescription for PT/OT/Nursing MDE Components Written orders obtained for MDE components requiring prescriptions. ISC/Eval Agency Not Ready No link Edit

SA Attachments

Document Responsible Status Link Actions
Consent for Evaluation/Screening Form (Attachment) Uploaded to Developmental Assessment tab of submitted SA. ISC Not Ready No link Edit
Consent to Obtain and Release Information Form (Attachment) Uploaded to Developmental Assessment tab of submitted SA. ISC Not Ready No link Edit
Family Concerns, Priorities and Resources (CPR) Form (Attachment) Uploaded to Developmental Assessment tab of submitted SA. ISC Not Ready No link Edit
Initial Service Coordination Consents Form (Attachment) Uploaded to Developmental Assessment tab of submitted SA. ISC Not Ready No link Edit

SA Attachments (Conditional)

Document Responsible Status Link Actions
Reason for Delay/MDE Submission Form Section I (Attachment) Uploaded if applicable due to delay risks. ISC Not Ready No link Edit

Phase 5: Post-Evaluation & IFSP Scheduling

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45-day IFSP deadline: Feb 05
This phase is initiated once the Multidisciplinary Evaluation (MDE) is complete, focusing on determining eligibility for the Early Intervention Program (EIP) and preparing the draft Individualized Family Service Plan (IFSP) document in the EI-Hub. The primary goal of this phase is coordinating with all required participants and notifying the parent to convene the initial IFSP meeting within the legally mandated 45 days of the child's referral.

MDE outcome & notifications

Confirm MDE receipt, review with family, and required notifications.

IFSP draft & scheduling

Draft IFSP and coordinate the meeting within 45 days.

Documents (Phase 5)

IFSP Draft

Document Responsible Status Link Actions
CPR Review Completed Family Concerns/Priorities/Resources reviewed ahead of IFSP discussion. ISC Not Ready No link Edit
Draft IFSP Created in EI-Hub IFSP created (Initial), start/end dates, method, dominant language confirmed. ISC Not Ready No link Edit
IFSP Team Panel Populated Parent, ISC, EIOD, Evaluation Rep entered from Family Info / assignments. ISC Not Ready No link Edit
Level of Development Panel Drafted Initial evaluation results entered by domain. ISC Not Ready No link Edit

MDE Outcome

Document Responsible Status Link Actions
Ineligible Child Flow Documented If ineligible, discuss safeguards, closure options, DM referral or re-eval. ISC Not Ready No link Edit
MDE Copy Provided to Family Family received MDE report/summary in appropriate language. ISC Not Ready No link Edit
MDE Packet Uploaded & Reviewed MDE uploaded to EI-Hub; ISC reviewed with family (eligibility determination d... Eval Agency / ISC Not Ready No link Edit

Notifications

Document Responsible Status Link Actions
OPWDD Notification (If Eligible) Notification of Potential Eligibility to OPWDD sent securely. ISC Not Ready No link Edit

Scheduling

Document Responsible Status Link Actions
Future IFSP Date Documented Future meeting date captured in written confirmation for continuity. ISC Not Ready No link Edit
IFSP Meeting Request/Confirmation Form (Section I) Section I completed and sent/faxed to RO within 48 hours of verbal confirmation. ISC Not Ready No link Edit
Notice of IFSP Meeting Sent Written confirmation to all attendees no less than 2 days before meeting. ISC Not Ready No link Edit

Time Log

Total: 0h 0m

No time logged yet.