Services / ESY Services

Last Name First Name Meeting Date

Teacher* Teacher*
  If the teacher is not listed in the pop-up, try entering the name or code here:
 
School* School*
  If the school is not listed in the pop-up, try entering the school name or code here:
 
Service* Service*
Primary Primary
Report to CASEMIS
 
Start date* Start date*
Location type* Location type*
Provider/responsible agency* Provider/responsible agency*
 
End (evaluation) date End (evaluation) date
Extended school year Extended school year
 
Duration (other description) Duration (other description)
(Describe if other:)   
 
Sessions per week Sessions per week
 
Frequency (other) Frequency (other)
(Describe if other:)   
 
Auxiliary service location Auxiliary service location
Individual/group Individual/group
Consult Consult
LEA district LEA district
 

The following items are required for infant and mental health services:
Provider type Provider type  (*infant/MHS)
Frequency code Frequency code  (*infant/MHS)
Duration, minutes per session Duration, minutes per session  (*infant/MHS)
 

The following items should be specified when the service has been discontinued:
Drop date
Drop reason Drop reason  (primary service only)
Drop code or reason Drop code or reason (non-primary service only)

For information only (no entry here):
Drop date
Primary drop reason - Non-primary drop reason -

*Required items