Service Coordinator/Provider Information

CONTACT

Available Forms (state suggested)

Inactive File Notification Form

Individualized Family Service Plan

Individualized Family Service Plan (Spanish)

Informed Clinical Opinion Form

Intake Form

Medicaid Authorization for Part C services

Parental Prior Notice/Consent Form

Parental Prior Notice/Consent Form (SPANISH)

Private Health Ins Authorization for Part C services

Record of Access Form

Referral Status Form

Release of Information Form

School District Notice to Parents Template

Screening Results Form

Surrogate Parent: Determination of Need

Surrogate Parent, Eligibility Verification Form

Transition Referral Form

Waiver of 45 Day IFSP Timeline Form

Provider Information

Medicaid Billing Manual

Benefits of Online Billing

Birth to Three Listserv

Medicaid Code and Rate Chart

Medicaid Training

Make-up Services

Request for Part C Payment

TA for Request for Part C Payment

Travel Time Reimbursement Tips

Travel Time Quick Sheet

Timely Service

CONTACT

If you have questions, please contact the Birth to Three, South Dakota Department of Education, at 605-773-3678, 800-305-3064.
800 Governors Drive, Pierre, SD 57501.