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Practice Manual
- Version Control Table
- Topic Index
- Chapter 1 – Mission, Purpose & Key Principles
- Chapter 2 – State Infrastructure
- Chapter 3 – Referral
- Chapter 4 – Intake
- Chapter 5 – Eligibility Determination
- Chapter 6 – Assessment for Service Planning
- Chapter 7 – IFSP Development
- Chapter 8 – IFSP Implementation and Review
- Chapter 9 – The Early Intervention Record
- Chapter 10 – Dispute Resolution
- Chapter 11 – Finance & Billing
- Chapter 12 – Personnel
- Glossary
General Supervision and Monitoring (GSM)
Click here to visit the GSM page of our website. Thank you.
Procedural Safeguards & Family Cost Share
Procedural Safeguards Documents
- Notice of Child and Family Rights and Safeguards Including Facts About Family Cost Share (PDF) – Updated 2024-01
- Strengthening Partnerships (PDF) – Updated 2024-04
- ITCVA Dispute Resolution Request Form (DOCX)
Procedural Safeguards Forms and Templates
- Confirmation of IFSP Schedule
- Confirmation of Scheduled Meetings/Activities
- Declining Early Intervention Services
- Family Cost Share (FCS) Agreement
- Family Cost Share TEMPORARY Agreement
- Family Cost Share Appeal
- Family Cost Share Fee Scale
- Notice and Consent to Determine Eligibility
- Notice and Consent for Assessment for Service Planning
- Notice of Action DMAS EI Services
- Notice to DMAS: Family Declining to Bill Private Insurance
- Parental Prior Notice
Other Forms and Templates
Activity Notes
Eligibility Determination
IFSP
- IFSP (Individualized Family Service Plan) (1044)
- IFSP (Individualized Family Service Plan) TRAC-IT Version 2022-09
- IFSP Summary Letter (3223A)
- IFSP Review Summary Letter
Local Contract for Participation in Part C
Memorandum of Agreement
Physician Certification
- Physician Certification Letter
- Physician Certification w/ Health Indicator Questions
- Physician Communication re: Health Indicator Questions
Referral
- Acknowledgement to Referral Source
- Referral Form – NON-Physician
- Referral Form – Physician
- Referral Form Instructions – Physician
Screening
- Hearing Screening Form REV 2024-05
- Hearing Screening Form Instructions REV 2024-07
- Vision Screening Form REV 2024-04
- Vision Screening Form Instructions REV 2024-04
Service Coordination
Surrogate Parents
- Notice to Biological Adoptive Parent
- Surrogate Parent Identification of Need
- Surrogate Parent Appointment
- Surrogate Parent Termination
Texting
Child Outcomes & Functional Assessment
Please refer to the Quicklinks section on the Child Outcomes & Functional Assessment page of our website. Thank you.
Family Survey
Family Outcomes and the Family Survey: Improving Experiences and Outcomes for Families in Early Intervention
Family Survey 2023
- Family Survey Flyer 2024 ENGLISH/SPANISH (PDF)
- Family Survey
- Family Survey ENGLISH (PDF)
- Family Survey SPANISH (PDF)
Fidelity Assessment
- Coaching in Action Checklist
- Coaching in Action Checklist: Tips & Clarifications
- Fidelity Assessment FAQs
- Fidelity Assessment Implementation At-A-Glance
- Local Coaching Fidelity Assessment Report ANY YEAR
- Preparing for Fidelity Assessment: A Webinar for Observers and Supervisors LINK
- Preparing for Fidelity Assessment: A Webinar for Providers LINK
- Video Recording Guidelines
Local System Monitoring Tools & Resources
General Monitoring and Supervision
- Local System Manager (LSM) Handbook UPDATED 2021-10
- ITOTS Reports for Local System Monitoring
- Quarterly Data Verification Reports: What? Why? How?
- Quality Record Review Tool
Child and Family Outcomes
- Toolkit for Analysis of Child and Family Outcomes
- Relationship of Quality Practices to Child and Family Outcome Measurement Results VIRGINIA | NATIONAL
Compliance Indicators
- IND 01 (Timely Initiation of Services) – Tracking Timeliness of Service Delivery EXCEL
- IND 07 (45-Day Timeline) – Tips for Monitoring Compliance
- IND 08 (Transition) – Tips for Monitoring Compliance
Fiscal Monitoring and Oversight
- Data Entry and Notification Requirements for the Medicaid EI Benefit YouTube
- How to Complete Your Initial Fiscal Form YouTube
- How to Complete Your Mid-Year and End-of-Year Fiscal Form YouTube
- How to Complete Your Federal Balance Report
- How to Make a Budget Revision YouTube
- How to Complete the Therapy Provider Report YouTube
Improvement Planning
- ITCVA Improvement Plan Template
Local System Orientation
These documents outline steps local system managers, supervisors, and fiscal officers can take to orient themselves to the Infant & Toddler Connection of Virginia’s early intervention system and administration.
Professional Development
Public Awareness
Developed by/for Virginia
- Public Awareness Order Form
- What Is Early Intervention? Flyer
- ITCVA Poster ENGLISH/SPANISH
- Public Awareness Materials Printing Instructions
- ITCVA Logo
- Virginia Best Practice Protocol for Hospitals Referring to ITCVA
- On Your Way – Skill-Building Worksheets for Families and Caregivers
Other Materials and Resources
Other/Miscellaneous
Foreign Language Documents
Over the years a number of core EI documents (e.g., procedural safeguards forms, the IFSP, etc.) have been translated into a number of languages. Use the links below to download ZIP files of the documents available in each language.
