South Carolina Department of Health and Environmental Control

We promote and protect the health of the public and the environment.

• "NEW" Medicaid Managed Care Organization (MCO) Information
• BabyNet Grant Application
• What is BabyNet?
• Early Intervention Services
• Frequently Asked Questions
• State ICC
• Policy Manual & Forms
• Links

Policy Manual and Forms

All the links below are in Adobe PDF format, please click here to download the free viewer.

BabyNet Policy and Procedure Manual

• Manual (Sections I - X)
• Appendix 1 IDEA Part C
• Appendix 2 BabyNet System Point of Entry Office Locations
• Appendix 3 Covered Diagnoses
• Appendix 5 Service Guide
• Appendix 6 Procedural Safeguards
• Appendix 7 Staffing (CSPD)
  • Credential Application
  • Credential Application Instructions
  • Table 1
  • Table 2
• Appendix 8 Monitoring
• Appendix 9 BabyNet Interagency Memorandum of Agreement
• Appendix 10 BabyTrac Users Guide
  
• Appendix 11 Procedures for Measuring Child and Family Outcomes
  • ECO Users Guide
  • Child Outcome Summary Form page 1
  • Child Outcome Summary Form page 3
  • ECO BNSC Checklist
  • ECO BNSP Checklist
    
• Appendix 12 Approved List of Curriculum Based Assessment Tools

BabyNet Forms and Instructions

• Form #BN001 IFSP
• Form #BN001 IFSP (Spanish)
  • BN001 IFSP Instructions
• Form #BN002 Refusal of Services
• Form #BN002 Refusal of Services (Spanish)
• Form #BN003 Birth and Early Health History
• Form #BN004 Insurance Resources
• Form #BN004 Insurance Resources (Spanish)
• Form #BN005 Consent for Screening, Evaluation and Assessment
• Form #BN005 Consent for Screening, Evaluation and Assessment (Spanish)
• Form #BN006 Consent to Release and/or Obtain Information
• Form #BN006 Consent to Release and/or Obtain Information (Spanish)
• Form #BN007 Family Vision and Hearing Questionnaire
  • BN007 Family Vision and Hearing Questionnaire Instructions
• Form #BN008 Interpretative Log
• Form #BN009 Record Access Log
• Form #BN010 Closure Letter
• Form #BN010 Closure Letter (Spanish)
• Form #BN011 Written Prior Notice/Meeting Notification
• Form #BN011 Written Prior Notice/Meeting Notification (Spanish)
• Form #BN012 Record Transmittal Cover Sheet
  • BN012 Record Transmittal Instructions
• Form #BN013 Family Guide to BabyNet Services
• Form #BN013 Family Guide to BabyNet Services (Spanish)
• Form #BN014 Notice of Child and Family Rights in the BabyNet System
• Form #BN014 Notice of Child and Family Rights in the BabyNet System (Spanish)
• Form #BN015 Provider Quarterly Progress Summary
• Form #BN016 Primary Health Care Provider Summary
• Form #BN017 Transition Referral
• Form #BN017 Transition Referral (Spanish)
• Form #BN018 Transition Conference
• Form #BN018 Transition Conference (Spanish)
• Form #BN019 Documentation of ICO
  • BN019 ICO Instructions
• Form #BN020 Assignment of Surrogate Parent
• Form #BN021 Transportation Log
• Form #BN021 Transportation Log (Spanish)
• Assistive Technology Request
• Autism Guidelines
  
• BabyNet Referral Form