Medicaid-Compliant Multi-Discipline Prescription Template

Multi-Discipline Template
Multi-Discipline Medicaid-Compliant Prescription Template for SERVICES (ESY & 10-Month):  CLICK HERE  
The Multi-Discipline Prescription Template with the "As per IEP" narrative has been removed from the Knowledge Base.  
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
(This Evaluation form is optional.  Since evaluations are not currently handled through the Portal, you may continue to use the county's evaluation template.)