COVID-19 Related Forms for Early Intervention
Nassau County Department of Health COVID-19 Attestation Form
- This attestation form immediately REPLACES the COVID Health Screening Assessment 5 day form AND the Acknowledgement of In Person Services form.
- The new form is to be completed by each provider working with a family ONE time only and kept in the child’s record. For example, if a family has 2 providers then each provider must complete the form ONCE.
- The family is also required to read and sign each form as it is an understanding between the provider and family.