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| |NEW JERSEY EARLY INTERVENTION SYSTEM PRACTITIONER IFSP REVIEW SUMMARY |
|Child’s Last Name |Child’s First Name |MI |DOB |SPOE ID # |
| | | | | |
|Current IFSP Start Date |Service Coordinator’s Name |County |
| | | |
| 6 month IFSP Periodic Review Other IFSP Periodic Review Annual IFSP Review |
|The practitioner must prepare this form with the parent or share a copy of the form with the parent and the SCU prior to the IFSP review. |
|EIP Practitioner’s Last Name |EIP Practitioner’s First Name |Discipline/Title |
| | | |
|EIP Agency Name |Authorized Early Intervention Service(s) |Date Prepared |
| | | |
|Family Outcomes: How have you helped the family? |
|Knowtheirrights |
|Effectivelycommunicatetheir child'sneeds |
|Helptheir childdevelopandlearn |
|Describe |
|Child Outcomes: How have you helped the child? |
|Develop positive social-emotionalskills(includingsocialrelationships) |
|Acquireanduseofknowledgeandskills(includingearlylanguage/communication). |
|Useappropriatebehaviorstomeettheirneeds. |
|Describe |
|The following information is provided for consideration at the upcoming IFSP review based upon my work with the child, the child’s family and other caregivers,|
|since the last IFSP review. |
|The following tools/early learning standards including ongoing assessments and curriculum (activities) were used with the child and family during the early |
|intervention service(s) authorization period. |
| |
| |
|Outcome |Outcome Progress/Status | |
|(List and provide progress on all current IFSP | |Challenges |
|outcomes) | | |
| |Initial/Baseline Status |Current Status/Progress | |
| | | | Yes |
| | | |No |
| | | | Yes |
| | | |No |
| | | | Yes |
| | | |No |
| | | | Yes |
| | | |No |
| | | | Yes |
| | | |No |
| | | | Yes |
| | | |No |
| | | | Yes |
| | | |No |
| | | | Yes |
| | | |No |
|If identifying challenges, describe the challenge(s) and strategies implemented to address the challenge(s)? |
| |
| |
| |
|Practitioner Signature |Date |
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