NYC EARLY INTERVENTION PROGRAM - Important Steps
NYC EARLY INTERVENTION PROGRAM SESSION NOTE
Child's Name: DOB: El#: (Last) (First)
Interventionist's Name: Discipline: Location of Service:
Date____/____/_____ Time: From ______am/pm To ______am/pm Service Type: __________ Date note written: _____/______/_____
(MM) (DD) (YY) Frequency/Duration___/___ Make Up For: _____/____/____
IFSP Outcome(s) Addressed:
Progress by child/family related to outcomes:
( Worked with parent/caregiver and child together ( Worked with parent/caregiver alone ( Worked with child alone
Activity During Session/Child/Family Response:
No Session Provided__Reason:__________________________________________________________________
Parent/Caregiver Signature: Relationship to child:
Interventionist Signature: Credentials/License#:
Date____/____/_____ Time: From ______am/pm To ______am/pm Service Type: __________ Date note written: _____/______/____ MM) (DD) (YY) Frequency/Duration___/___ Make Up For: _____/____/____
IFSP Outcome(s) Addressed:
Progress by child/family related to outcomes:
( Worked with parent/caregiver and child together ( Worked with parent/caregiver alone ( Worked with child alone
Activity During Session/Child/Family Response:
No Session Provided__Reason:__________________________________________________________________
Parent/Caregiver Signature: Relationship to child:
Interventionist Signature: Credentials/License#:
-----------------------
Important Steps, Inc.
( Therapist used alternate tool to work with parent/caregiver
(e.g., phone call, notebook)
( Parent/caregiver unavailable
Activity with parent/caregiver (check all that apply)
( Discussed session activity with parent/caregiver
( Showed parent/caregiver activity
( Parent/caregiver tried activity, therapist assisted
( Parent/caregiver unable to participate
List Family Plan/Calendar activity for next week:
( Therapist used alternate tool to work with parent/caregiver
(e.g., phone call, notebook)
( Parent/caregiver unavailable
Activity with parent/caregiver (check all that apply)
( Discussed session activity with parent/caregiver
( Showed parent/caregiver activity
( Parent/caregiver tried activity, therapist assisted
( Parent/caregiver unable to participate
List Family Plan/Calendar activity for next week:
................
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