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Intake Form Record of Access Form
Service Coordinator Map
Referral Status Form Release of Information Form
Surrogate Parent: Determination of Need Surrogate Parent, Eligibility Verification Form

Consent to Screen Form Consent to Screen Form (Spanish)

2018 Prior Written Notice 2018 Prior Written Notice (Spanish)
Consent to Evaluate Consent to Evaluate (Spanish)
Informed Clinical Opinion Form
Informed Clinical Opinion Definition and Technical Assistance
Birth to Three Exit Assessment

2018 IFSP Meeting Notice Invitation 2018 IFSP Meeting Notice Invitation (Spanish)
Decline of Services Individualized Family Service Plan
Medicaid Authorization for Part C services Medicaid Authorization for Part C services (Spanish)
Private Health Ins Authorization for Part C services

Inactive File Notification Form School District Notice to Parents Template
Transition Referral Form

Medicaid Billing Manual Medicaid Code and Rate Chart
Medicaid Training Travel Time Reimbursement Tips
Travel Time Quick Sheet Request for Primary Physician Approval

Home Visiting
Birth to Three Listserv Physicians' Guide
Early Intervention in Childcare Setting Video Recording EI Sessions Form

Information coming soon


If you have questions, or would like to schedule screening, contact:
South Dakota Department of Education
South Dakota Birth to Three
800 Governors Drive, Pierre, SD 57501
605-773-3678, 800-305-3064.