Medicaid-Compliant OT/PT Prescription Template

CPSEPortal > Medicaid Documentation
OT/PT PRESCRIPTION TEMPLATE

Medicaid-Compliant OT/PT Prescription Templates:  
2026-27 Blank Template (all options are manually entered), click here.
2026-27 Template (with dropdown options), 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 requiring that all prescriptions show the specific frequency, duration and class designation (I/G).  




















Article ID: 347, , Modified: 9/29/2026 at 2:42 PM

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