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Get California Children's Services Medical Therapy Program - Therapy Assessment Plan. Dhcs 4098

S number The above child has been referred to the California Children s Services (CCS) Medical Therapy Program (MTP) for a physical therapy (PT) and/or an occupational therapy (OT) assessment for medically necessary therapy services. The following tests that have been checked will be administrated to your child to allow the therapist(s) to develop a proposed therapy plan. Please sign below and mail or deliver this form to: County CCS Program , CA Clinical Observations: The therapist s obs.

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