Birth to Three, SD Department of Education

Birth to Three:
Service Coordinators

Referral/Intake

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

Screening

Consent to Screen Form
Consent to Screen Form (Spanish)

Evaluation

Parental Prior Written Notice
Parental Prior Written Notice (Spanish)
Consent to Evaluate
Consent to Evaluate (spanish)
Informed Clinical Opinion Form
Birth to Three Exit Assessment

IFSP

IFSP Meeting Invitation
2018 IFSP Meeting Notice Invitation (Spanish)
Decline of Services
IFSP Process Flowchart
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

Transition

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

Billing

Medicaid Billing Manual
Medicaid Code and Rate Chart
Medicaid Training
Request for Primary Physician Approval

Other

Home Visiting

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

Birth to Three: Service Coordinators

Birth to Three:
Service Coordinators