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When Occupational Therapy Services Require a Prescription or Referral

Disclaimer: Law, rules and regulations, not Guidelines, specify the requirements for practice and violating them constitutes professional misconduct. Not adhering to this Guideline may be interpreted as professional misconduct only if the conduct also violates pertinent law, rules and regulations.

Occupational therapists can perform occupational therapy evaluations without a referral or prescription. However, to implement an OT treatment plan, under certain circumstances described below, you must have a referral or prescription from a licensed health care provider acting within his or her scope of practice .

Effective February 3, 2012, Education Law §7901 was amended to provide that an occupational therapy treatment program "designed to restore function" must be rendered on the prescription or referral of a physician, nurse practitioner or other health care provider acting within his or her scope of practice.

Prior to this amendment, an occupational therapist could only provide treatment following receipt of a prescription or referral, provided by a physician or nurse practitioner.

The board has interpreted this change to mean that an OT treatment program that is not restoring a function can be provided without a script, and believes that this would apply typically to school age children receiving therapy to assist them in developing functions they do not currently possess. Treatment programs involving handwriting, literacy and learning disorders are examples of such therapy.

However, a treatment program for adults, who have lost function due to a stroke or accident and who require therapy to restore their ability to perform activities of daily living, such as dressing, bathing and household mobility, would still only be able to be performed after receipt of a prescription or referral.

Additionally, Medicaid, an insurance provider or school district may still have a policy that would require a prescription or referral in all instances. However, barring such a policy, an occupational therapist or occupational therapy assistant should not deprive a client of needed services, due to the lack of a prescription or referral when that client is receiving therapy under a treatment program not designed to restore function.

When required, prescriptions and referrals establish an important link between the patient's/client's occupational therapist and his/her primary healthcare provider because they set forth a client’s diagnosis and provide direction as to the frequency or type of therapy required.

The referral/prescription becomes part of the record which the occupational therapist must maintain for each patient/client he or she serves.