UDO/USO Documents (All Full-Service Medicaid Counties)

CPSEPortal > Medicaid Documentation
Columbia County

Dutchess County
Dutchess County UDO Accessibility Certification Form for OT/PT:  click here
Dutchess County UDO Accessibility Certification Form for Speech:  click here

Herkimer County
Herkimer County UDO Accessibility Certification Form for OT/PT & Speech:  click here
Herkimer County UDO Child Log for OT/PT & Speech:  click here

Jefferson County
UDO Accessibility Form - OT/PT:  click here
UDO Log for OT/PT:  click here
UDO Accessibility Form - Speech: click here
UDO Log for Speech: click here

Livingston County
UDO Accessibility Form - OT/PT:  click here
UDO Log for OT/PT:  click here
UDO Accessibility Form - Speech:  click here
UDO Log for Speech:  click here

Nassau County
UDO Forms & Instructions (OT/PT/ST):  click here
USO Forms & Instructions (Psychological Counseling): click here
UDO Nursing Forms & Instructions:  click here

Niagara County 
    Identification of Supervisor Form - OT  Click here
    Monthly Supervisory Case Notes - OT  Click here
Identification of Supervisor Form - PT  Click here
Monthly Supervisory Case Notes - PT  Click here   
Identification of Supervisor Form - ST  Click here
Monthly Supervisory Case Notes - ST Click here

Orange County
Orange County UDO Child Log & Accessibility Certification Form for OT/PT & ST: click here

Rockland County
UDO Accessibility Form - OT/PT:  click here
UDO Log for OT/PT:  click here
UDO Accessibility Form - Speech:  click here
UDO Log for Speech: click here

Sullivan County
    UDO Accessibility Form and UDO Log - OT/PT:  click here
    UDO Accessibility Form and UDO Log - Speech:  click here

Ulster County
UDO Accessibility Form - OT/PT:  click here
UDO Log for OT/PT:  click here
UDO Accessibility Form - Speech:  click here
UDO Log for Speech:  click here
USO Accessibility Form - Psychological Counseling:  click here
USO Log for Psychological Counseling:  click here

Westchester County
UDO Accessibility Form - Speech:  click here
UDO Child Log - Speech:  click here
UDO Accessibility Form - OT/PT:  click here
UDO Child Log - OT/PT:  click here
UDO Accessibility Form - Psychological Counseling:  click here
UDO Child Log - Psychological Counseling:  click here
UDO Accessibility Form - Skilled Nursing:  click here
UDO Log - Skilled Nursing:  click here

S A M P L E   U D O  F O R M S - click here
(Samples of a completed Child Log & Accessibility Form)



Article ID: 466, , Modified: 5/6/2025 at 2:07 PM

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