HEMS SPIFR Question  

The autopilot has a minimum engagement airspeed, usually around 60 KIAS in most aircraft.  Some part of the ITO will be accomplished hand-flown until that speed is reached.  Depending on the aircraft, you can be in ATT mode, have HDG bug and level off altitude set, but the initial part of the departure is all you.  It's advisable to initiate a stable climb also while hand-flying, unless you prefer going 70 knots at 50 feet while looking down for the flight director buttons.