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Standard Documentation Forms

Operational Forms

Last Updated: September 24, 2024

All documents are in PDF format. PDF

ADMINISTRATIVE POSTING DATE
Change of Information/RAU Transfer Form January 9, 2026
Change of Information/RAU Transfer Form - INSTRUCTIONS June 2, 2022
Practitioner Confirmation Form new February 20, 2025
Practitioner Confirmation Form Instructions new February 20, 2025
Prior Approval for E-A Services PCF new March 5, 2025
AT/AUDIOLOGICAL POSTING DATE

Clarification of Process for Identifying and Accessing Assistive Technology Service

Original posting date: July 1, 2017 - REVISION DATE: February15, 2022.

May 8, 2023

AT Equipment Loan Agreement February 29, 2024
Assistive Technology, Audiological Services and Interpreter Service Authorization Request Form February 29, 2024
Assistive Technology, Audiological Services and Interpreter Service Authorization Request Form - SAMPLE June 17, 2024
Assistive Technology Assessment Form February 29, 2024
Assistive Technology Service Authorization Checklist June 17, 2024
COMMUNICATION LOGS POSTING DATE
Correspondence/Phone Contact Log May 29, 2024
Missed Appointment Documentation February 29, 2024
WVBTT Prescreen for COVID-19 February 29, 2024
IFSP POSTING DATE
Authorization for Team Units and Documentation of Transition Conference Form

May 29, 2024

Authorization for Team Units and Documentation of Transition Conference Form - INSTRUCTIONS

October 14, 2022

IFSP - Individualized Family Service Plan new September 3, 2025
Individualized Family Service Plan INSTRUCTIONS November 10, 2022
IFSP - Additional Page February 29, 2024
IFSP Child Outcome - Additional page new
IFSP Child Outcomes in Child Care Routines - Additional page new

February 18, 2025
February 18, 2025

IFSP Family Outcome - Additional Page February 29, 2024
IFSP Review new January 21, 2025
Teaming Activity Note February 29, 2024
Teaming Activity Note - INSTRUCTIONS
COSF-Decision Tree For Summary Rating Discussions March 5, 2025
2.0 Definition of Developmental Delay new May 1, 2025
INTERVENTION ACTIVITY NOTES POSTING DATE
Intervention Activity Note February 29, 2024
Intervention Activity Note - Instructions October 5, 2022
RECORD REQUESTS POSTING DATE
Service Coordinator Request to Release Child Records February 29, 2024
REFERRAL/INTAKE POSTING DATE
General Referral Form for WVBTT March 13, 2025
SERVICE COORDINATION ACTIVITY NOTES POSTING DATE
Service Coordination Activity Note October 13, 2022
Service Coordination Activity Note - INSTRUCTIONS October 5, 2022
TRANSITION POSTING DATE
EXIT- Child Outcome Summary Form (COSF) new September 29, 2025

EXIT - Child Outcome Summary Form (COSF) - INSTRUCTIONS

June 8, 2022

Transition Checklist February 29, 2024
Transition/Exit Form February 29, 2024
Transition/Exit Form - INSTRUCTIONS June 2, 2022
Transition Plan February 29, 2024
WV Birth to Three Transition Summary Update February 29, 2024
OSC/ISC RESOURCES POSTING DATE
Assistive Technology-DME Vendors Listing July 7, 2023
Audiological Service Providers Listing February 8, 2024
Daily Family Routines Handout February 29, 2024
Documentation Submission Chart August 4, 2022
Parent Letter of Request for Part B Services
Procedural Safeguards Notice June 2, 2022
Procedural Safeguards Notice - Spanish June 2, 2022
State Complaint Brochure August 8, 2024
State Complaint Form July 17, 2024
The Components of Functional, Meaningful Child Outcomes June 2, 2022
Transition Cheat Sheet June 2, 2022
Transition Resource Information new June 5, 2025
Vision Service Providers Listing July 7, 2023
OSC/ISC RESOURCES POSTING DATE
Application for Over-Ride of Denied Claim new July 14, 2025
SSA-DDS Contact Form February 29, 2024
WVBTT Photo Release Form new August 6, 2025