Physical Therapy, Occupational Therapy, and Speech and Language Pathology Services
 
 

Certification and Ongoing Responsibilities

Supervision Requirements

Declaration of Supervision

Physical therapist assistants, COTAs and SLP provider assistants are required to complete the Declaration of Supervision for Nonbilling Providers form, HCF 1182 (fillable PDF, 36 KB), for changes in physical address or supervising therapist. The completion instructions and form are located in Appendix 3 and Appendix 4 of this handbook for photocopying and may also be downloaded and printed from the Medicaid Web site.

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