COUNTY OCCUPATIONAL THERAPY PROGRESS NOTES/LOGS



____________ COUNTY OCCUPATIONAL THERAPY PROGRESS NOTES/LOGS-1256665118110 LAST NAME FIRST NAME BIRTHDATE PROVIDER NUMBER MEDICAID NUMBERDIAG. CODE WVEIS# SCHOOLProc. CodeUNITS Proc. CodeUNITSSee Attached IEP Goals and Objectives Circle Future Goal: A. Continue IEP until completion date B. Reconvene IEP Team to address change00 LAST NAME FIRST NAME BIRTHDATE PROVIDER NUMBER MEDICAID NUMBERDIAG. CODE WVEIS# SCHOOLProc. CodeUNITS Proc. CodeUNITSSee Attached IEP Goals and Objectives Circle Future Goal: A. Continue IEP until completion date B. Reconvene IEP Team to address changeBEGINNING DATE: ENDING DATE: I-85725-1270 Date mm/dd/yyTime InTime OutIEP Goals &Objectives Procedure Code(s) Activity/Progress OTR Signature: Date mm/dd/yyTime InTime OutIEP Goals & Objectives Procedure Code(s) Activity/Progress OTR Signature: Date mm/dd/yyTime InTime OutIEP Goals &Objectives Procedure Code(s) Activity/Progress Date mm/dd/yyTime InTime OutIEP Goals & Objectives Procedure Code(s) Activity/Progress OTR Signature: 00 Date mm/dd/yyTime InTime OutIEP Goals &Objectives Procedure Code(s) Activity/Progress OTR Signature: Date mm/dd/yyTime InTime OutIEP Goals & Objectives Procedure Code(s) Activity/Progress OTR Signature: Date mm/dd/yyTime InTime OutIEP Goals &Objectives Procedure Code(s) Activity/Progress Date mm/dd/yyTime InTime OutIEP Goals & Objectives Procedure Code(s) Activity/Progress OTR Signature: Billing Code Procedure – 15 minute unitsBilling code 97003Therapy Evaluation (one per year) 97150 GOTherapeutic procedure(s), group (2 or more)- billed by session 97004Therapy Re-evaluation (one per 6 mo) 97530 GOTherapeutic activities, direct (one on one) 97110 GOTherapeutic exercises 97532 GODevelopment of cognitive skills, direct (one on one) 97112 GONeuromuscular Reeducation 97533 GOSensory integrative techniques, direct (one on one) 97116 GOGait Training (stair climbing, etc.) ................
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