NYS Early Intervention Report Template

Two fully editable speech-language evaluation report templates save you a ton of time! These reports reflect both qualifying and non-qualifying clients. Assessment Materials Used: Pre-School Language Scale – 5th Edition (PLS-5)

Rossetti Infant Toddler Language Scale

Westby Play Scale

HELP Checklist

Appendix E-Clinical Cues Adapted From the NYS EIP Clinical Practice Guidelines

Informal Language Sample

Behavioral Observation

Informed Clinical Opinion

Parent Interview: The Critical Questions for SLP Early Intervention Evaluators

What you can find in this template:

*fully editable Word document

*15 pages of report writing

*Report segmented into:

-Background and Reason for Evaluation

-Behavioral Observations

-Tests Administered

-Results with standardized scores

-Non-Standardized Measures (Oral motor structure, the appearance of weakness,

vocal quality, hearing screenings)

-Standards and Procedures for Evaluations, Evaluation Reimbursement, and Eligibility Requirements Under the EIP

-Summary / Impressions

-Recommendations

Please note this report was written by an SLP in NYC. Modification of this template is recommended based on individual student reports.

**Important: This report template was written by me, as a school-based Speech-Language Pathologist. They can be easily adapted to other tests and specialties. I have no affiliation with Pearson and this product does not replace the need to buy the official and updated batteries of assessment and protocols from them. This report template should be a time saver and guide in writing time-consuming reports that can be shared with parents, other specialists, teachers, and CSE teams. Please ensure this report is completely modified to adapt to your students.