Medicaid-Compliant OT/PT Prescription Template

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.
2025-26 Template (Will be removed from Knowledge Base.)  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).