Individualized Family Service Plan (IFSP)
Virginia has adopted a revised statewide Individualized Family Service Plan (IFSP). This form is available in an electronic version to be completed on the computer and a version to be completed by hand. There is also a version of the IFSP for those with Word 2003 along with a memo describing how to use it.
An IFSP form that addresses Medicaid’s Targeted Case Management (TCM) requirements is also available in electronic or hand versions. Additional IFSP Outcome pages are available for regular and TCM versions.
Also included are instructions for completing the IFSP including page-by-page directions. Additional information regarding the completion of the IFSP can be found by reading the IFSP Talking Points and the IFSP Q&A documents. A sample physician letter for referral and evaluation (.pdf) as well as a sample physician certification letter can also be found on this site.An IFSP Flow Sheet shows the steps in the IFSP process including required procedural safeguards at each step in the process.
- Farsi IFSP (pdf) (Word)
- Farsi TCM IFSP (pdf) (Word)
- Korean IFSP (pdf) (Word)
- Korean TCM IFSP (pdf) (Word)
- Spanish IFSP (pdf) (Word) (Electronic)
- Spanish TCM IFSP (pdf) (Word)
- Vietnamese IFSP (pdf) (Word)
- Vietnamese TCM IFSP (pdf) (Word)