Medicaid-Compliant Multi-Discipline Prescription Template

Multi-Discipline Prescription Template (ESY & 10-Month)

Multi-Discipline Medicaid-Compliant Prescription Template for SERVICES:  CLICK HERE  

Important Note:  The Multi-Discipline Prescription Template with the "As per IEP" narrative has been removed from the Knowledge Base.  Please discontinue using any "Per IEP" templates.  
  • All Full-Service Medicaid counties are no longer accepting prescriptions that reference the IEP for the frequency and duration.  
  • All 2025-26 prescriptions MUST show the specific frequency, duration and class designation (e.g., 2x30 Ind).  

Multi-Discipline Medicaid-Compliant Prescription Template for EVALUATIONS:  CLICK HERE