Medicaid-Compliant OT/PT Prescription Template


Link to Medicaid-Compliant Prescription Template for SCHOOL YEAR (7/1 to 6/30):  Click here
Use this template if Annual Reviews are conducted with school year service dates.

Link to Medicaid-Compliant Prescription Template for CALENDAR YEAR (specific service dates): Click here
Use this template if Annual Reviews are conducted using a calendar year -  not specific to a 7/1 to 6/30 school year.
The Term of Service Prescription Dates must match the IEP Service Dates.