Where does it go?
Which Form Do You Use?
Case Note V. Service
Who does it go to?

Parent Permissions Narrative

What is in the binder in Permissions/Notification section?


The parent informs you that they are adding another person to their pick up list.

What is Authorization Release of Child?

The Authorization Release of child is maintained in the Permissions/Notification section of the binder, uploaded to MYHEADSTART and a copy is given to the classroom.


Family Advocate distributed the handout, Car Seat Safety, to families.

What is a Service, Parent Training Handout Log, Safety Awareness? 


Parent Interest Survey Form

What is scanned to MHS Request email and FSM?

The Parent Interest Survey is coalated and used to plan the sites parent trainings and Family Meeting topics.


I am renewed every year and expire after the date on the form OR the child has left the program.

All releases, consents and Face Sheet?


DCF Release of Information

What is uploaded to MYHEADSTART and in  the DCF Slots section of the binder?


The child's physical states that the child is allergic to milk.

What is IHCP and Diet Modification forms?  

Both must be signed by the physician, parent and reviewed by the Health Specialist.  The IHCP and Diet Modification form is maintained in the child's binder and copies are given to the classroom.


I called and spoke with Alice (mom). She has decided to enroll Abbey into our Program. Alice had some questions about the program when I first spoke with her. We planned to discuss her questions and complete enrollment paperwork at an Enrollment Zoom meeting on 10/30 at 2pm.

What is a Case Note?


Child's Updated Physical

What is sent to the Health Office with a "cc" to the FA or HV and the Family Services Assistant? 

The Health Office and Family Services Assistant (if working with one) is notified of any appointment dates if obtained via email.  An update is added to the Internal Referral with any new information. 


I am used for each file to keep track of all the enrollment documents and the document's completion.

What is the Enrollment/Renewal Paperwork Checklist?


Child and Family Assessments

What is uploaded to MYHEADSTART and for families in DCF slots sent to the DCF Social Worker as the family's quarterly review requirement?


The parent requests copies of the child's birth certificate and most current physical and immunizations for the child's registration to Kindergarten.

What is the Personally Identifiable Information (PII) form?

When given directly to the parent the form is completed and sent to the FSM. If the parent is requesting that the form be sent directly to the public school, a current release of information is required.


Second FPP meeting completed. Family is very happy with our program, Abbey loves her teachers. Also we had conversation about some important days such as last day of school, Family meeting, last day celebration, and returning to school after summer break.

What is neither a service or case note?  

This is an update in the IFPA in Plan Update History.


BTC Release of Information

What is scanned to MHS Request email?


This is the first step I take after two or three calls/texts to the family with no response when I am trying to reach a family to complete their enrollment.

What is send a "Trying to Reach You" letter?

If still no response, speak to your supervisor.  They may suggest you buddy up and knock on the door.  Also document your attempts to enroll in Case Notes and keep the Enrollment department updated on the status of enrollment.


Transfer Request

What is the Enrollment section of the binder?


You have arranged with the family to complete the Family Partnership Plan.

What is the IFPA form entered through the Home Visit tab in MYHEADSTART?

The paper form is no longer used.  An electronic signature is requested from the parent through MHS.  If unable to obtain an electronic signature from the parent then the form is downloaded and printed for the parent to sign (wet signature).  The form is only printed when the parent signs with a wet signature. In that case the form with the original wet signature is then uploaded to MHS in the Plan Update History section of the IFPA on the date of that meeting and filed in the Family Engagement section of the child's binder.


The Family Services Manager sends out the new Touchpoints Parent Group flyer with instructions to send to all families.

What is a Service?

Parent Training Handout Log>Information about Touchpoints Parent Groups.


Transportation Change/ Request form

What is the Transportation Office?


I update this form every time a child changes their placement or funding source but I do not create a new one each time.  

What is First Page Cover Sheet?


Immunization and Physical Checklist Initial Enrollment

What is Health and Nutrition section of the binder?


This will be the child's last year with HSELP.  The child will graduate to kindergarten in August. This form should be completed with the parent so that the transition information may be shared with the child's new kindergarten teacher.

What is the Education Release of Information form?

Whenever the paperwork is completed at enrollment or renewed for a returning child, and you anticipate the child will transition to kindergarten, the Education ROI form must be completed.  The actual name of the school should be listed.


Follow up for vision and lead for Abbey. Mom has orders for lead test but didn't want to get them done on the day of the physical due to the shots the Abbey received. She will let FA know when she brings them for the test. Mom will be making Abbey an eye exam appt. as the doctor stated she will need glasses.

What is Update to Internal Referral (Service)?  

Anytime there is updated information regarding an Internal Referral for health (no matter who the IR is assigned to) the update goes in that, not a case note.


An officer of the court hands you a subpoena form which is instructing you to provide the child's file to the court on XX/XXXX date.

What is the Family Services Manager?

Whenever a court order is received at your site for any reason the FSM must be immediately notified and a copy provided for review.  The FSM will instruct you on next steps.


This notification is given to the parent annually (at enrollment and paperwork renewal) to notify them of their Parental Rights to PII. 

What is Annual Notice Regarding Personally Identifiable Information (PII) and Parental Rights? 

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