Medicaid-Compliant OT/PT Prescription Template

OT/PT PRESCRIPTION TEMPLATE

Medicaid-Compliant OT/PT Prescription Template:  Click here

Important Note:  
The OT/PT 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).