Medicaid-Compliant Multi-Discipline Prescription Template

Multi-Discipline Prescription Templates 

Multi-Discipline Medicaid-Compliant Prescription Templates for SERVICES:  
2026-27 Blank Template (all options are manually entered), click here.
2026-27 Template (with dropdown options), click here.
2025-26 Template (Will be removed from the Knowledge Base.) click here.

Multi-Discipline Medicaid-Compliant Prescription Template for EVALUATIONS:  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).