<p> HARCATUS HEAD START CHILD’S FILE CHECKLIST Forms should be placed in the files in the following manner unless otherwise noted.** Timeline Purple Tab-Family or event Yellow Tab - Enrollment Orange Tab - Education Green Tab-Health Services Enrollment Head Start Child Enrollment Form Initial ODJFS Child Enrollment & Initial Home Visit Report Parent Health Contract Family Engagement Home Visit Health Information ECDHS109 Health History Booklet Family Agreement Transition Checklist HIPAA Receipt Notice Attendance Agreement (into/transfer) Routine Field Trip Permission Within 30 Medical Statement days Immunization Record Within 45 Copy of Birth Certificate ASQ-3 Dental Health Form days Copy of Medical/Insurance Articulation Screener Hearing Screening Card Hearing Referral Form Vision Screening Vision Referral Form Oct.-Nov Conference Report Lead Results or within 3 ECDHS113 (initial section Hemoglobin Results months completed) Kindergarten Transition Parent Survey (before) by Feb. Conference Reports 28/within ECDHS113 (mid-year 6 months section completed) Kindergarten Transition Packet May- For IEP students, print June/at 8 GOLD months Individual profile and GOLD observations Conference Reports ECDHS113 (final home Pocket – Transition visit section) Place copies for transition Transition Checklist (to here as documents are Kind.) received. Kindergarten Transition · Social Security Card Parent Survey (after) · Birth Certificate As Needed Custody Documents If Needed Home Visit Report Child Observation Form · Custody Papers · Health History or filed at Home-School ECDHS124 Incident Reports · Medical Statement Form year’s end Correspondence Permission Slips ECDHS104B,C Request for Admin. of ECDHS127 PIES Medication · Dental Health Form Change of Status** Anecdotal Observation Child Medical/Physical Care · Immunization Record Attendance Referrals Booklet Plan** · GOLD (Winter Data) Parent/Guardian Refusal for Medication Error Form · Hearing & Vision Immunizations Treatment Letter Screening Parent/Guard. Refusal for Follow- Up Services Blue Tab – Social-Emotional-Behavioral/IEP ASQ-SE (Completed on ALL children within 45 days from enrollment) Social/Emotional/Behavioral Referral Process :</p><p>ECDHS119 **Items should be placed at front of that section. REV 6/15 NOTE: IF A CHILD HAS AN IEP, THE ITEMS LISTED BELOW MUST BE · Consent to Release Info. HSFCP010 sent to Dis./Prev./MH PUT IN THE FRONT OF THIS SECTION FOR EASY AND FREQUENT Mgr required to start S/E/B Referral process ACCESS: · Consent for Observation ECDHS801 sent to Dis./Prev./MH · IEP File Review Documentation Form ECDHS611 Mgr required to start S/E/B Referral process · MFE/ETR · Social/Emotional/Behavioral Referral ECDHS800 & 800A · IEP · Individualized Instruction Sheet ECDHS612a completed by staff/parent; Signed by Teacher sent to · Special Needs Conference Report ECDHS613 Disabilities/Prev./Mental Health Mgr · Notification of IEP Meeting ECDHS609 or copy of · Child Mental Health Observation – ECDHS 802 & 802A notification from school · Child Intervention Plan - ECDHS805 IEP Process : · Family Recommendation Plan – ECDHS806 · Screening Permission Slip ECDHS600 · Family Recommendation Plan Update – ECDHS 806A · Home Visit Permission Slip ECDHS601 · If child also has IEP, get Consent to Release Info. · Special Needs Home Visit Report ECDHS602 HSFCP010 for parental permission for Mental Health · LEA or Service Provider Cover Letter ECDHS603 Consultant to view ETR & IEP · Referral for Evaluation (PR-04) · Consent for Evaluation ECDHS607 As needed: · Consent to Release Information HSFCP010 · Behavior Observation Form – ECDHS 804 · Parent Information ECDHS604 · Behavior Assessment Instructions/Form – ECDHS 804A & · Evaluation Team Report (Part A) 804B · Letter of Response ECDHS 605 · Behavior Baseline Tracking Chart Instructions Form – · Referral Information ECDHS 804C · Intervention Tracking Chart – ECDHS 807</p><p>ECDHS119 **Items should be placed at front of that section. REV 6/15 2016 Child File</p><p>This is a guide, please see Initial Home Visit Report to Before a child with special conditions can be in complete the documentation of items listed attendance a health care plan(s) & administration of medication form MUST be completed. If medication is required it must also be provided and properly labeled Required tasks/items before child can start attending: prior to attendance. Child may be enrolled and not in  Initial Home Visit attendance for 10 days to complete process.  Copy of CEHI & Family Agree in attendance, bus notebook  Health Conditions (including environmental allergies)  Bus route revised to accommodate new student o Health care plans complete and shared with all drivers o Staff trained on health care plan by parent or health professional  Updated bus route placed on bus and copy in center  T  CA  SNA  FA  FSA  files BA  Local subs o Medication Administration Form completed o Medication Administration in Medication Bag Recommended prepared materials o Health Care Plan in bus notebook & attendance  Child cubby labeled with name and photo notebook  Food Allergy o Medication Administration Form Completed o Health care plan completed  Label for journal, toothbrush & paste, who’s here chart, o Staff trained on health care plan by parent or health job chart tag, bus seat, meal table tag, etc. professional  T  CA  SNA  FA  FSA  BA  Local subs – When Necessary o Health Care Plan in bus notebook & attendance notebook o Medication administration completed o Medication Administration in Medication Bag</p><p>ECDHS119 **Items should be placed at front of that section. REV 6/15 ECDHS119 **Items should be placed at front of that section. REV 6/15</p>