G9փqL:CG\*3mOjd`XZbvwUU*dU[=|:{'L|p`{Gys4ʀ: ķgxn:9ז:9 j9%'.&synY@iw"`lDBJbBVtIqsF$ T$ [rb$á5AXMq+!R]$3KZGcPw) jݍD,rRIS̑= ^PH) BՏ_dӠyAs gyBzZ (Pz'<#E79̥^{&jM9}& &6 ݨB.O_ ueFcJl::qX\8J3 ߪQPB>AlVE)CB).dOO NBd}1AB~}j*$14Z[ugY qV E%Ŏa!EiU ؋/f1*.wo0y9į}Iw[יz)occoЛ$nHrk63`?r+53f޲>j*wШMm8Y#0w*C-`ڱF*lj&& ËKw\G`߽n˒Ftub#m1Dǵ.zwIF>Iܤ,+ TĂ Z\/.+ %vt*w(.iz3 5bDygG}e[/ʢOmֺ^BrJla#k}xU$YXT*6O,u,4:uɧFs;gm+tSk>C+$VWW-k!rJȧe`B ,GGZSU'MuVU*dWXV:L~b݃yGyr4ˀ: ķgxn:9֖:9 j4i ֍sD9nY@iw"`lDBJbBVtIqsF$ T$ [rb$á5AXMq+!R]$3KZGcPw) jݍD,rRIS̑= ^PHYʘ϶+As gyBz*biؚM`3 rHǍHJE79̥^{&jM9}& &w9ۀs/iK9ueFcR㔞:6X]9J3ުQPB>AzM&Â?gQ߶d<822g/L>L9?Field5|Field5 =Field5 Field5 \h CheckBox148 CheckBox14Й CheckBox14Field5 \Field5 GField5 ϿField5  Field5 oField5TField5!\7Field5#FField:2%߻Field:8%3Field:9% AField:10% \Field:11% %Field:12% %Field:2'߻Field:8'@ Field:9' B Field:10' A Field:11' d{B Field:12' A Field:2)߻Field:8)L@ Field:9) F Field:10) \G Field:11) !4G Field:12) "C Field:2+#߻Field:8+$,C Field:9+ %C Field:10+ &C Field:11+ 'C Field:12+ (C Field:2-)߻Field:8-*G Field:9- +G Field:10- ,|G Field:11- -dG Field:12- .LG Field:2./߻Field:8.0H Field:9. 1"H Field:10. 2+H Field:11. 34H Field:12. 4$>H Field:215߻Field:816H Field:91 7H Field:101 8|H Field:111 9dH Field:121 :H Field:23;߻Field:83<YI Field:93 =aI Field:103 >jI Field:113 ?sI Field:123 @|I %Table37'Table37)Table37+Table37-Table37.Table371Table373Table37LPage822HLayer?ܴ0is 3 D s&Label18s&>Q  Ld <d"ArialtSerifiPdaaaadaddG^^^^^^^^{\rtf1\ansi\ansicpg1252\deff0\deflang1033{\fonttbl{\f0\fswiss\fprq2\fcharset0 Arial;}} {\colortbl ;\red0\green0\blue0;} \viewkind4\uc1\pard\sl240\slmult1\qc\cf1\b\f0\fs20 Medicaid Therapy Claiming Log\par } D s&Label18s&>Q  Ld <d"ArialtSerifiPdaaaadaddG^^^^^^^^{\rtf1\ansi\ansicpg1252\deff0\deflang1033{\fonttbl{\f0\fswiss\fprq2\fcharset0 Arial;}} {\colortbl ;\red0\green0\blue0;} \viewkind4\uc1\pard\sl240\slmult1\qc\cf1\f0\fs16 PLEASE PRINT CLEARY. VERIFY STUDENT IS ON THE EXCEL FILE SENT TO MAXIMUS\par } D 8s&6Label188s&6>Q  Ld <d"ArialtSerifiPdaaaadaddG^^^^^^^^{\rtf1\ansi\ansicpg1252\deff0\deflang1033{\fonttbl{\f0\fswiss\fprq2\fcharset0 Arial;}} {\colortbl ;\red0\green0\blue0;} \viewkind4\uc1\pard\sl240\slmult1\qc\cf1\f0\fs16 All information below is \b\i REQUIRED\b0\i0 and must be filled out completely.\par } D {uasLabel18{uas>Q  Ld <d"ArialtSerifiPdaaaadaddG^^^^^^^^{\rtf1\ansi\ansicpg1252\deff0\deflang1033{\fonttbl{\f0\fswiss\fprq2\fcharset0 Arial;}} {\colortbl ;\red0\green0\blue0;} \viewkind4\uc1\pard\sl240\slmult1\cf1\f0\fs16 School Districts County-District (CD) Code (6 digits):\par } D "us rtField58"us   Ld <d"ArialtSerifiPNew Roman# & g xI[2[d2[H2[d dTimes New Roman#6 D {aLabel18{a>Q  Ld <d"ArialtSerifiPdaaaadaddG^^^^^^^^{\rtf1\ansi\ansicpg1252\deff0\deflang1033{\fonttbl{\f0\fswiss\fprq2\fcharset0 Arial;}} {\colortbl ;\red0\green0\blue0;} \viewkind4\uc1\pard\sl240\slmult1\cf1\f0\fs16 Therapy Type (check one)\par } D UuMsLabel18UuMs>Q  Ld <d"ArialtSerifiPdaaaadaddG^^^^^^^^{\rtf1\ansi\ansicpg1252\deff0\deflang1033{\fonttbl{\f0\fswiss\fprq2\fcharset0 Arial;}} {\colortbl ;\red0\green0\blue0;} \viewkind4\uc1\pard\sl240\slmult1\cf1\f0\fs16 District Name:\par } D u's  rtField58u's   Ld <d"ArialtSerifiPNew Roman# & g xI[2[d2[H2[d dTimes New Roman#6 D U Label18U>Q  Ld <d"ArialtSerifiPdaaaadaddG^^^^^^^^{\rtf1\ansi\ansicpg1252\deff0\deflang1033{\fonttbl{\f0\fswiss\fprq2\fcharset0 Arial;}} {\colortbl ;\red0\green0\blue0;} \viewkind4\uc1\pard\sl240\slmult1\cf1\f0\fs16 Other (specify):\par } D '  rtField58'   Ld <d"ArialtSerifiPNew Roman# & g xI[2[d2[H2[d dTimes New Roman#6 D { Label18{>Q  Ld <d"ArialtSerifiPdaaaadaddG^^^^^^^^{\rtf1\ansi\ansicpg1252\deff0\deflang1033{\fonttbl{\f0\fswiss\fprq2\fcharset0 Arial;}} {\colortbl ;\red0\green0\blue0;} \viewkind4\uc1\pard\sl240\slmult1\cf1\f0\fs16 Student Name: Last:\par } D   rtField58   Ld <d"ArialtSerifiPNew Roman# & g xI[2[d2[H2[d dTimes New Roman#6D  CheckBox148   4x  D  Label18  >Q  Ld <d"ArialtSerifiPdaaaadaddG^^^^^^^^{\rtf1\ansi\ansicpg1252\deff0\deflang1033{\fonttbl{\f0\fswiss\fprq2\fcharset0 Arial;}} {\colortbl ;\red0\green0\blue0;} \viewkind4\uc1\pard\sl240\slmult1\cf1\f0\fs16 Occupational\par } De c CheckBox148e c  4x  D cLabel18c>Q  Ld <d"ArialtSerifiPdaaaadaddG^^^^^^^^{\rtf1\ansi\ansicpg1252\deff0\deflang1033{\fonttbl{\f0\fswiss\fprq2\fcharset0 Arial;}} {\colortbl ;\red0\green0\blue0;} \viewkind4\uc1\pard\sl240\slmult1\cf1\f0\fs16 Physical\par } D CheckBox148  4x  D XLabel18X>Q  Ld <d"ArialtSerifiPdaaaadaddG^^^^^^^^{\rtf1\ansi\ansicpg1252\deff0\deflang1033{\fonttbl{\f0\fswiss\fprq2\fcharset0 Arial;}} {\colortbl ;\red0\green0\blue0;} \viewkind4\uc1\pard\sl240\slmult1\cf1\f0\fs16 Speech\par } D UQLabel18UQ>Q  Ld <d"ArialtSerifiPdaaaadaddG^^^^^^^^{\rtf1\ansi\ansicpg1252\deff0\deflang1033{\fonttbl{\f0\fswiss\fprq2\fcharset0 Arial;}} {\colortbl ;\red0\green0\blue0;} \viewkind4\uc1\pard\sl240\slmult1\cf1\f0\fs16 First:\par } D A rtField58A   Ld <d"ArialtSerifiPNew Roman# & g xI[2[d2[H2[d dTimes New Roman#6 D =!Label18=!>Q  Ld <d"ArialtSerifiPdaaaadaddG^^^^^^^^{\rtf1\ansi\ansicpg1252\deff0\deflang1033{\fonttbl{\f0\fswiss\fprq2\fcharset0 Arial;}} {\colortbl ;\red0\green0\blue0;} \viewkind4\uc1\pard\sl240\slmult1\cf1\f0\fs16 M.I.:\par } D >!' rtField58>!'   Ld <d"ArialtSerifiPNew Roman# & g xI[2[d2[H2[d dTimes New Roman#6 D {. , Label18{. , >Q  Ld <d"ArialtSerifiPdaaaadaddG^^^^^^^^{\rtf1\ansi\ansicpg1252\deff0\deflang1033{\fonttbl{\f0\fswiss\fprq2\fcharset0 Arial;}} {\colortbl ;\red0\green0\blue0;} \viewkind4\uc1\pard\sl240\slmult1\cf1\f0\fs16 Student ID (LEA assigned):\par } D m . ,  rtField58m . ,    Ld <d"ArialtSerifiPNew Roman# & g xI[2[d2[H2[d dTimes New Roman#6 D U. , Label18U. , >Q  Ld <d"ArialtSerifiPdaaaadaddG^^^^^^^^{\rtf1\ansi\ansicpg1252\deff0\deflang1033{\fonttbl{\f0\fswiss\fprq2\fcharset0 Arial;}} {\colortbl ;\red0\green0\blue0;} \viewkind4\uc1\pard\sl240\slmult1\cf1\f0\fs16 Medicaid #\par } D . ',  rtField58. ',    Ld <d"ArialtSerifiPNew Roman# & g xI[2[d2[H2[d dTimes New Roman#6 D {k i Label18{k i >Q  Ld <d"ArialtSerifiPdaaaadaddG^^^^^^^^{\rtf1\ansi\ansicpg1252\deff0\deflang1033{\fonttbl{\f0\fswiss\fprq2\fcharset0 Arial;}} {\colortbl ;\red0\green0\blue0;} \viewkind4\uc1\pard\sl240\slmult1\cf1\f0\fs16 Students Medical ICD-9 Diagnosis Code:\par } D k i  rtField58 k i    Ld <d"ArialtSerifiPNew Roman# & g xI[2[d2[H2[d dTimes New Roman#6 D Uk i Label18Uk i >Q  Ld <d"ArialtSerifiPdaaaadaddG^^^^^^^^{\rtf1\ansi\ansicpg1252\deff0\deflang1033{\fonttbl{\f0\fswiss\fprq2\fcharset0 Arial;}} {\colortbl ;\red0\green0\blue0;} \viewkind4\uc1\pard\sl240\slmult1\cf1\f0\fs16 Student Date of Birth:\par } D k 'i  rtField5(. Z?G)#v@;?F8 k 'i    Miscellaneous ObjectsEd d"ArialtSerifiNew Roman# & g xI[2[d2[H2[d dTimes New Roman#6eMM/dd/yyyy D {  Label18{  >Q  Ld <d"ArialtSerifiPdaaaadaddG^^^^^^^^{\rtf1\ansi\ansicpg1252\deff0\deflang1033{\fonttbl{\f0\fswiss\fprq2\fcharset0 Arial;}} {\colortbl ;\red0\green0\blue0;} \viewkind4\uc1\pard\sl240\slmult1\cf1\f0\fs16 Therapist's Name: Last:\par } D   ! rtField58     Ld <d"ArialtSerifiPNew Roman# & g xI[2[d2[H2[d dTimes New Roman#6 D U Q "Label18U Q >Q  Ld <d"ArialtSerifiPdaaaadaddG^^^^^^^^{\rtf1\ansi\ansicpg1252\deff0\deflang1033{\fonttbl{\f0\fswiss\fprq2\fcharset0 Arial;}} {\colortbl ;\red0\green0\blue0;} \viewkind4\uc1\pard\sl240\slmult1\cf1\f0\fs16 First:\par } D  A # rtField58 A    Ld <d"ArialtSerifiPNew Roman# & g xI[2[d2[H2[d dTimes New Roman#6 D {& '$$Label18{& '$>Q  Ld <d"ArialtSerifiPdaaaadaddG^^^^^^^^ {\rtf1\ansi\ansicpg1252\deff0\deflang1033{\fonttbl{\f0\fswiss\fprq2\fcharset0 Arial;}} {\colortbl ;\red0\green0\blue0;} \viewkind4\uc1\pard\sl240\slmult1\cf1\f0\fs16 Note: \expndtw-2 Refer to the Fast Guide for diagnosis codes and CPT Proxy codes.\expndtw0\par } D {c'%[prTable378{c'  L<}   D {c4 rtField:18{c4xy codes.\expndt  Ld <d"ArialtSerifxP{\rtf1\ansi\ansicpg1252\deff0\deflang1033{\fonttbl{\f0\fswiss\fprq2\fcharset0 Arial;}} {\colortbl ;\red0\green0\blue0;} \viewkind4\uc1\pard\sl240\slmult1\qc\cf1\f0\fs16 Therapy Date\par } D{4 rtField:2(. Z?G)#v@;?F8{4xy codes.\expndt  Miscellaneous ObjectsEd d"ArialtSerifxeMM/dd/yy D 4c rtField:384cxy codes.\expndt  Ld <d"ArialtSerifxP{\rtf1\ansi\ansicpg1252\deff0\deflang1033{\fonttbl{\f0\fswiss\fprq2\fcharset0 Arial;}} {\colortbl ;\red0\green0\blue0;} \viewkind4\uc1\pard\sl240\slmult1\qc\cf1\f0\fs16 Proxy\par Code\par } D c  rtField:48c xy codes.\expndt  Ld <d"ArialtSerifxP{\rtf1\ansi\ansicpg1252\deff0\deflang1033{\fonttbl{\f0\fswiss\fprq2\fcharset0 Arial;}} {\colortbl ;\red0\green0\blue0;} \viewkind4\uc1\pard\sl240\slmult1\qc\cf1\f0\fs16 Begin\par Time\par } D c rtField:58 cxy codes.\expndt  Ld <d"ArialtSerifxP{\rtf1\ansi\ansicpg1252\deff0\deflang1033{\fonttbl{\f0\fswiss\fprq2\fcharset0 Arial;}} {\colortbl ;\red0\green0\blue0;} \viewkind4\uc1\pard\sl240\slmult1\qc\cf1\f0\fs16 End\par Time\par } D c rtField:68cxy codes.\expndt  Ld <d"ArialtSerifxP{\rtf1\ansi\ansicpg1252\deff0\deflang1033{\fonttbl{\f0\fswiss\fprq2\fcharset0 Arial;}} {\colortbl ;\red0\green0\blue0;} \viewkind4\uc1\pard\sl240\slmult1\qc\cf1\f0\fs16 Units\par (max of 5)\par } D c' rtField:78c'xy codes.\expndt  Ld <d"ArialtSerifxP9{\rtf1\ansi\ansicpg1252\deff0\deflang1033{\fonttbl{\f0\fswiss\fprq2\fcharset0 Arial;}} {\colortbl ;\red0\green0\blue0;} \viewkind4\uc1\pard\sl240\slmult1\qc\cf1\expndtw-2\f0\fs15 Briefly describe activities, exercises and equipment used,\par as wellas progress toward IEP therapy goals.\expndtw0\fs16\par } D 4 rtField:884xy codes.\expndt  Ld <d"ArialtSerifxP D    rtField:98 xy codes.\expndt  Ld <d"ArialtSerifxP D   rtField:108 xy codes.\expndt  Ld <d"ArialtSerifxP D   rtField:118xy codes.\expndt  Ld <d"ArialtSerifxP D '  rtField:128'xy codes.\expndt  Ld <d"ArialtSerifxP${c' ${c4 $fcha4c $fchac  $fcha c $fchac $c' ${' $fcha{4 $fcha4 $fcha   $   $fcha  $fcha'  D {&Label18{ >Q  Ld <d"ArialtSerifiPdaaaadaddG^^^^^^^^{\rtf1\ansi\ansicpg1252\deff0\deflang1033{\fonttbl{\f0\fswiss\fprq2\fcharset0 Arial;}} {\colortbl ;\red0\green0\blue0;} \viewkind4\uc1\pard\sl240\slmult1\cf1\f0\fs16 Therapist's Signature:\par } D {''[prTable378{'  L<}   D {4 rtField:18{4xy codes.\expndt  Ld <d"ArialtSerifxP{\rtf1\ansi\ansicpg1252\deff0\deflang1033{\fonttbl{\f0\fswiss\fprq2\fcharset0 Arial;}} {\colortbl ;\red0\green0\blue0;} \viewkind4\uc1\pard\sl240\slmult1\qc\cf1\f0\fs16 Therapy Date\par } D{4 rtField:2(. Z?G)#v@;?F8{4xy codes.\expndt  Miscellaneous ObjectsEd d"ArialtSerifxeMM/dd/yy D 4 rtField:384xy codes.\expndt  Ld <d"ArialtSerifxP{\rtf1\ansi\ansicpg1252\deff0\deflang1033{\fonttbl{\f0\fswiss\fprq2\fcharset0 Arial;}} {\colortbl ;\red0\green0\blue0;} \viewkind4\uc1\pard\sl240\slmult1\qc\cf1\f0\fs16 Proxy\par Code\par } D   rtField:48 xy codes.\expndt  Ld <d"ArialtSerifxP{\rtf1\ansi\ansicpg1252\deff0\deflang1033{\fonttbl{\f0\fswiss\fprq2\fcharset0 Arial;}} {\colortbl ;\red0\green0\blue0;} \viewkind4\uc1\pard\sl240\slmult1\qc\cf1\f0\fs16 Begin\par Time\par } D  rtField:58 xy codes.\expndt  Ld <d"ArialtSerifxP{\rtf1\ansi\ansicpg1252\deff0\deflang1033{\fonttbl{\f0\fswiss\fprq2\fcharset0 Arial;}} {\colortbl ;\red0\green0\blue0;} \viewkind4\uc1\pard\sl240\slmult1\qc\cf1\f0\fs16 End\par Time\par } D  rtField:68xy codes.\expndt  Ld <d"ArialtSerifxP{\rtf1\ansi\ansicpg1252\deff0\deflang1033{\fonttbl{\f0\fswiss\fprq2\fcharset0 Arial;}} {\colortbl ;\red0\green0\blue0;} \viewkind4\uc1\pard\sl240\slmult1\qc\cf1\f0\fs16 Units\par (max of 5)\par } D ' rtField:78'xy codes.\expndt  Ld <d"ArialtSerifxP9{\rtf1\ansi\ansicpg1252\deff0\deflang1033{\fonttbl{\f0\fswiss\fprq2\fcharset0 Arial;}} {\colortbl ;\red0\green0\blue0;} \viewkind4\uc1\pard\sl240\slmult1\qc\cf1\expndtw-2\f0\fs15 Briefly describe activities, exercises and equipment used,\par as wellas progress toward IEP therapy goals.\expndtw0\fs16\par } D 4 rtField:884xy codes.\expndt  Ld <d"ArialtSerifxP D    rtField:98 xy codes.\expndt  Ld <d"ArialtSerifxP D   rtField:108 xy codes.\expndt  Ld <d"ArialtSerifxP D   rtField:118xy codes.\expndt  Ld <d"ArialtSerifxP D '  rtField:128'xy codes.\expndt  Ld <d"ArialtSerifxP${' ${4 $fcha4 $fcha  $fcha  $fcha $' ${' $fcha{4 $fcha4 $fcha   $   $fcha  $fcha'  D {')[prTable378{'  L<}   D {4M rtField:18{4Mxy codes.\expndt  Ld <d"ArialtSerifxP{\rtf1\ansi\ansicpg1252\deff0\deflang1033{\fonttbl{\f0\fswiss\fprq2\fcharset0 Arial;}} {\colortbl ;\red0\green0\blue0;} \viewkind4\uc1\pard\sl240\slmult1\qc\cf1\f0\fs16 Therapy Date\par } D{M4 rtField:2(. Z?G)#v@;?F8{M4xy codes.\expndt  Miscellaneous ObjectsEd d"ArialtSerifxeMM/dd/yy D 4M rtField:384Mxy codes.\expndt  Ld <d"ArialtSerifxP{\rtf1\ansi\ansicpg1252\deff0\deflang1033{\fonttbl{\f0\fswiss\fprq2\fcharset0 Arial;}} {\colortbl ;\red0\green0\blue0;} \viewkind4\uc1\pard\sl240\slmult1\qc\cf1\f0\fs16 Proxy\par Code\par } D  M rtField:48 Mxy codes.\expndt  Ld <d"ArialtSerifxP{\rtf1\ansi\ansicpg1252\deff0\deflang1033{\fonttbl{\f0\fswiss\fprq2\fcharset0 Arial;}} {\colortbl ;\red0\green0\blue0;} \viewkind4\uc1\pard\sl240\slmult1\qc\cf1\f0\fs16 Begin\par Time\par } D M rtField:58 Mxy codes.\expndt  Ld <d"ArialtSerifxP{\rtf1\ansi\ansicpg1252\deff0\deflang1033{\fonttbl{\f0\fswiss\fprq2\fcharset0 Arial;}} {\colortbl ;\red0\green0\blue0;} \viewkind4\uc1\pard\sl240\slmult1\qc\cf1\f0\fs16 End\par Time\par } D M rtField:68Mxy codes.\expndt  Ld <d"ArialtSerifxP{\rtf1\ansi\ansicpg1252\deff0\deflang1033{\fonttbl{\f0\fswiss\fprq2\fcharset0 Arial;}} {\colortbl ;\red0\green0\blue0;} \viewkind4\uc1\pard\sl240\slmult1\qc\cf1\f0\fs16 Units\par (max of 5)\par } D 'M rtField:78'Mxy codes.\expndt  Ld <d"ArialtSerifxP9{\rtf1\ansi\ansicpg1252\deff0\deflang1033{\fonttbl{\f0\fswiss\fprq2\fcharset0 Arial;}} {\colortbl ;\red0\green0\blue0;} \viewkind4\uc1\pard\sl240\slmult1\qc\cf1\expndtw-2\f0\fs15 Briefly describe activities, exercises and equipment used,\par as wellas progress toward IEP therapy goals.\expndtw0\fs16\par } D 4M rtField:884Mxy codes.\expndt  Ld <d"ArialtSerifxP D M   rtField:98M xy codes.\expndt  Ld <d"ArialtSerifxP D M  rtField:108 Mxy codes.\expndt  Ld <d"ArialtSerifxP D M  rtField:118Mxy codes.\expndt  Ld <d"ArialtSerifxP D M'  rtField:128M'xy codes.\expndt  Ld <d"ArialtSerifxP${'M ${4M $fcha4M $fcha M $fcha M $fchaM $'M ${M' $fcha{M4 $fcha4M $fchaM   $ M  $fchaM  $fchaM'  D {(Label18{ >Q  Ld <d"ArialtSerifiPdaaaadaddG^^^^^^^^{\rtf1\ansi\ansicpg1252\deff0\deflang1033{\fonttbl{\f0\fswiss\fprq2\fcharset0 Arial;}} {\colortbl ;\red0\green0\blue0;} \viewkind4\uc1\pard\sl240\slmult1\cf1\f0\fs16 Therapist's Signature:\par } D {*Label18{ >Q  Ld <d"ArialtSerifiPdaaaadaddG^^^^^^^^{\rtf1\ansi\ansicpg1252\deff0\deflang1033{\fonttbl{\f0\fswiss\fprq2\fcharset0 Arial;}} {\colortbl ;\red0\green0\blue0;} \viewkind4\uc1\pard\sl240\slmult1\cf1\f0\fs16 Therapist's Signature:\par } D {'@ +[prTable378{'@   L<}   D {4 rtField:18{4xy codes.\expndt  Ld <d"ArialtSerifxP{\rtf1\ansi\ansicpg1252\deff0\deflang1033{\fonttbl{\f0\fswiss\fprq2\fcharset0 Arial;}} {\colortbl ;\red0\green0\blue0;} \viewkind4\uc1\pard\sl240\slmult1\qc\cf1\f0\fs16 Therapy Date\par } D{4@  rtField:2(. Z?G)#v@;?F8{4@ xy codes.\expndt  Miscellaneous ObjectsEd d"ArialtSerifxeMM/dd/yy D 4 rtField:384xy codes.\expndt  Ld <d"ArialtSerifxP{\rtf1\ansi\ansicpg1252\deff0\deflang1033{\fonttbl{\f0\fswiss\fprq2\fcharset0 Arial;}} {\colortbl ;\red0\green0\blue0;} \viewkind4\uc1\pard\sl240\slmult1\qc\cf1\f0\fs16 Proxy\par Code\par } D   rtField:48 xy codes.\expndt  Ld <d"ArialtSerifxP{\rtf1\ansi\ansicpg1252\deff0\deflang1033{\fonttbl{\f0\fswiss\fprq2\fcharset0 Arial;}} {\colortbl ;\red0\green0\blue0;} \viewkind4\uc1\pard\sl240\slmult1\qc\cf1\f0\fs16 Begin\par Time\par } D  rtField:58 xy codes.\expndt  Ld <d"ArialtSerifxP{\rtf1\ansi\ansicpg1252\deff0\deflang1033{\fonttbl{\f0\fswiss\fprq2\fcharset0 Arial;}} {\colortbl ;\red0\green0\blue0;} \viewkind4\uc1\pard\sl240\slmult1\qc\cf1\f0\fs16 End\par Time\par } D  rtField:68xy codes.\expndt  Ld <d"ArialtSerifxP{\rtf1\ansi\ansicpg1252\deff0\deflang1033{\fonttbl{\f0\fswiss\fprq2\fcharset0 Arial;}} {\colortbl ;\red0\green0\blue0;} \viewkind4\uc1\pard\sl240\slmult1\qc\cf1\f0\fs16 Units\par (max of 5)\par } D ' rtField:78'xy codes.\expndt  Ld <d"ArialtSerifxP9{\rtf1\ansi\ansicpg1252\deff0\deflang1033{\fonttbl{\f0\fswiss\fprq2\fcharset0 Arial;}} {\colortbl ;\red0\green0\blue0;} \viewkind4\uc1\pard\sl240\slmult1\qc\cf1\expndtw-2\f0\fs15 Briefly describe activities, exercises and equipment used,\par as wellas progress toward IEP therapy goals.\expndtw0\fs16\par } D 4@  rtField:884@ xy codes.\expndt  Ld <d"ArialtSerifxP D  @  rtField:98 @ xy codes.\expndt  Ld <d"ArialtSerifxP D @  rtField:108 @ xy codes.\expndt  Ld <d"ArialtSerifxP D @  rtField:118@ xy codes.\expndt  Ld <d"ArialtSerifxP D '@  rtField:128'@ xy codes.\expndt  Ld <d"ArialtSerifxP${' ${4 $fcha4 $fcha  $fcha  $fcha $' ${'@ $fcha{4@ $fcha4@ $fcha @  $ @  $fcha@  $fcha'@  D {@ >!,Label18{@ >! >Q  Ld <d"ArialtSerifiPdaaaadaddG^^^^^^^^{\rtf1\ansi\ansicpg1252\deff0\deflang1033{\fonttbl{\f0\fswiss\fprq2\fcharset0 Arial;}} {\colortbl ;\red0\green0\blue0;} \viewkind4\uc1\pard\sl240\slmult1\cf1\f0\fs16 Therapist's Signature:\par } D {=!'$-[prTable378{=!'$  L<}   D {=!4" rtField:18{=!4"xy codes.\expndt  Ld <d"ArialtSerifxP{\rtf1\ansi\ansicpg1252\deff0\deflang1033{\fonttbl{\f0\fswiss\fprq2\fcharset0 Arial;}} {\colortbl ;\red0\green0\blue0;} \viewkind4\uc1\pard\sl240\slmult1\qc\cf1\f0\fs16 Therapy Date\par } D{"4$ rtField:2(. Z?G)#v@;?F8{"4$xy codes.\expndt  Miscellaneous ObjectsEd d"ArialtSerifxeMM/dd/yy D 4=!" rtField:384=!"xy codes.\expndt  Ld <d"ArialtSerifxP{\rtf1\ansi\ansicpg1252\deff0\deflang1033{\fonttbl{\f0\fswiss\fprq2\fcharset0 Arial;}} {\colortbl ;\red0\green0\blue0;} \viewkind4\uc1\pard\sl240\slmult1\qc\cf1\f0\fs16 Proxy\par Code\par } D =! " rtField:48=! "xy codes.\expndt  Ld <d"ArialtSerifxP{\rtf1\ansi\ansicpg1252\deff0\deflang1033{\fonttbl{\f0\fswiss\fprq2\fcharset0 Arial;}} {\colortbl ;\red0\green0\blue0;} \viewkind4\uc1\pard\sl240\slmult1\qc\cf1\f0\fs16 Begin\par Time\par } D =!" rtField:58 =!"xy codes.\expndt  Ld <d"ArialtSerifxP{\rtf1\ansi\ansicpg1252\deff0\deflang1033{\fonttbl{\f0\fswiss\fprq2\fcharset0 Arial;}} {\colortbl ;\red0\green0\blue0;} \viewkind4\uc1\pard\sl240\slmult1\qc\cf1\f0\fs16 End\par Time\par } D =!" rtField:68=!"xy codes.\expndt  Ld <d"ArialtSerifxP{\rtf1\ansi\ansicpg1252\deff0\deflang1033{\fonttbl{\f0\fswiss\fprq2\fcharset0 Arial;}} {\colortbl ;\red0\green0\blue0;} \viewkind4\uc1\pard\sl240\slmult1\qc\cf1\f0\fs16 Units\par (max of 5)\par } D =!'" rtField:78=!'"xy codes.\expndt  Ld <d"ArialtSerifxP9{\rtf1\ansi\ansicpg1252\deff0\deflang1033{\fonttbl{\f0\fswiss\fprq2\fcharset0 Arial;}} {\colortbl ;\red0\green0\blue0;} \viewkind4\uc1\pard\sl240\slmult1\qc\cf1\expndtw-2\f0\fs15 Briefly describe activities, exercises and equipment used,\par as wellas progress toward IEP therapy goals.\expndtw0\fs16\par } D 4"$ rtField:884"$xy codes.\expndt  Ld <d"ArialtSerifxP D " $  rtField:98" $xy codes.\expndt  Ld <d"ArialtSerifxP D "$  rtField:108 "$xy codes.\expndt  Ld <d"ArialtSerifxP D "$  rtField:118"$xy codes.\expndt  Ld <d"ArialtSerifxP D "'$  rtField:128"'$xy codes.\expndt  Ld <d"ArialtSerifxP${=!'" ${=!4" $fcha4=!" $fcha=! " $fcha =!" $fcha=!" $=!'" ${"'$ $fcha{"4$ $fcha4"$ $fcha" $  $ "$  $fcha"$  $fcha"'$  D {%').[prTable378{%')  L<}   D {%4p' rtField:18{%4p'xy codes.\expndt  Ld <d"ArialtSerifxP{\rtf1\ansi\ansicpg1252\deff0\deflang1033{\fonttbl{\f0\fswiss\fprq2\fcharset0 Arial;}} {\colortbl ;\red0\green0\blue0;} \viewkind4\uc1\pard\sl240\slmult1\qc\cf1\f0\fs16 Therapy Date\par } D{p'4) rtField:2(. Z?G)#v@;?F8{p'4)xy codes.\expndt  Miscellaneous ObjectsEd d"ArialtSerifxeMM/dd/yy D 4%p' rtField:384%p'xy codes.\expndt  Ld <d"ArialtSerifxP{\rtf1\ansi\ansicpg1252\deff0\deflang1033{\fonttbl{\f0\fswiss\fprq2\fcharset0 Arial;}} {\colortbl ;\red0\green0\blue0;} \viewkind4\uc1\pard\sl240\slmult1\qc\cf1\f0\fs16 Proxy\par Code\par } D % p' rtField:48% p'xy codes.\expndt  Ld <d"ArialtSerifxP{\rtf1\ansi\ansicpg1252\deff0\deflang1033{\fonttbl{\f0\fswiss\fprq2\fcharset0 Arial;}} {\colortbl ;\red0\green0\blue0;} \viewkind4\uc1\pard\sl240\slmult1\qc\cf1\f0\fs16 Begin\par Time\par } D %p' rtField:58 %p'xy codes.\expndt  Ld <d"ArialtSerifxP{\rtf1\ansi\ansicpg1252\deff0\deflang1033{\fonttbl{\f0\fswiss\fprq2\fcharset0 Arial;}} {\colortbl ;\red0\green0\blue0;} \viewkind4\uc1\pard\sl240\slmult1\qc\cf1\f0\fs16 End\par Time\par } D %p' rtField:68%p'xy codes.\expndt  Ld <d"ArialtSerifxP{\rtf1\ansi\ansicpg1252\deff0\deflang1033{\fonttbl{\f0\fswiss\fprq2\fcharset0 Arial;}} {\colortbl ;\red0\green0\blue0;} \viewkind4\uc1\pard\sl240\slmult1\qc\cf1\f0\fs16 Units\par (max of 5)\par } D %'p' rtField:78%'p'xy codes.\expndt  Ld <d"ArialtSerifxP9{\rtf1\ansi\ansicpg1252\deff0\deflang1033{\fonttbl{\f0\fswiss\fprq2\fcharset0 Arial;}} {\colortbl ;\red0\green0\blue0;} \viewkind4\uc1\pard\sl240\slmult1\qc\cf1\expndtw-2\f0\fs15 Briefly describe activities, exercises and equipment used,\par as wellas progress toward IEP therapy goals.\expndtw0\fs16\par } D 4p') rtField:884p')xy codes.\expndt  Ld <d"ArialtSerifxP D p' )  rtField:98p' )xy codes.\expndt  Ld <d"ArialtSerifxP D p')  rtField:108 p')xy codes.\expndt  Ld <d"ArialtSerifxP D p')  rtField:118p')xy codes.\expndt  Ld <d"ArialtSerifxP D p'')  rtField:128p'')xy codes.\expndt  Ld <d"ArialtSerifxP${%'p' ${%4p' $fcha4%p' $fcha% p' $fcha %p' $fcha%p' $%'p' ${p'') $fcha{p'4) $fcha4p') $fchap' )  $ p')  $fchap')  $fchap'')  D {$%/Label18{$% >Q  Ld <d"ArialtSerifiPdaaaadaddG^^^^^^^^{\rtf1\ansi\ansicpg1252\deff0\deflang1033{\fonttbl{\f0\fswiss\fprq2\fcharset0 Arial;}} {\colortbl ;\red0\green0\blue0;} \viewkind4\uc1\pard\sl240\slmult1\cf1\f0\fs16 Therapist's Signature:\par } D {)*0Label18{)* >Q  Ld <d"ArialtSerifiPdaaaadaddG^^^^^^^^{\rtf1\ansi\ansicpg1252\deff0\deflang1033{\fonttbl{\f0\fswiss\fprq2\fcharset0 Arial;}} {\colortbl ;\red0\green0\blue0;} \viewkind4\uc1\pard\sl240\slmult1\cf1\f0\fs16 Therapist's Signature:\par } D {*'c.1[prTable378{*'c.  L<}   D {*4', rtField:18{*4',xy codes.\expndt  Ld <d"ArialtSerifxP{\rtf1\ansi\ansicpg1252\deff0\deflang1033{\fonttbl{\f0\fswiss\fprq2\fcharset0 Arial;}} {\colortbl ;\red0\green0\blue0;} \viewkind4\uc1\pard\sl240\slmult1\qc\cf1\f0\fs16 Therapy Date\par } D{',4c. rtField:2(. Z?G)#v@;?F8{',4c.xy codes.\expndt  Miscellaneous ObjectsEd d"ArialtSerifxeMM/dd/yy D 4*', rtField:384*',xy codes.\expndt  Ld <d"ArialtSerifxP{\rtf1\ansi\ansicpg1252\deff0\deflang1033{\fonttbl{\f0\fswiss\fprq2\fcharset0 Arial;}} {\colortbl ;\red0\green0\blue0;} \viewkind4\uc1\pard\sl240\slmult1\qc\cf1\f0\fs16 Proxy\par Code\par } D * ', rtField:48* ',xy codes.\expndt  Ld <d"ArialtSerifxP{\rtf1\ansi\ansicpg1252\deff0\deflang1033{\fonttbl{\f0\fswiss\fprq2\fcharset0 Arial;}} {\colortbl ;\red0\green0\blue0;} \viewkind4\uc1\pard\sl240\slmult1\qc\cf1\f0\fs16 Begin\par Time\par } D *', rtField:58 *',xy codes.\expndt  Ld <d"ArialtSerifxP{\rtf1\ansi\ansicpg1252\deff0\deflang1033{\fonttbl{\f0\fswiss\fprq2\fcharset0 Arial;}} {\colortbl ;\red0\green0\blue0;} \viewkind4\uc1\pard\sl240\slmult1\qc\cf1\f0\fs16 End\par Time\par } D *', rtField:68*',xy codes.\expndt  Ld <d"ArialtSerifxP{\rtf1\ansi\ansicpg1252\deff0\deflang1033{\fonttbl{\f0\fswiss\fprq2\fcharset0 Arial;}} {\colortbl ;\red0\green0\blue0;} \viewkind4\uc1\pard\sl240\slmult1\qc\cf1\f0\fs16 Units\par (max of 5)\par } D *'', rtField:78*'',xy codes.\expndt  Ld <d"ArialtSerifxP9{\rtf1\ansi\ansicpg1252\deff0\deflang1033{\fonttbl{\f0\fswiss\fprq2\fcharset0 Arial;}} {\colortbl ;\red0\green0\blue0;} \viewkind4\uc1\pard\sl240\slmult1\qc\cf1\expndtw-2\f0\fs15 Briefly describe activities, exercises and equipment used,\par as wellas progress toward IEP therapy goals.\expndtw0\fs16\par } D 4',c. rtField:884',c.xy codes.\expndt  Ld <d"ArialtSerifxP D ', c.  rtField:98', c.xy codes.\expndt  Ld <d"ArialtSerifxP D ',c.  rtField:108 ',c.xy codes.\expndt  Ld <d"ArialtSerifxP D ',c.  rtField:118',c.xy codes.\expndt  Ld <d"ArialtSerifxP D ','c.  rtField:128','c.xy codes.\expndt  Ld <d"ArialtSerifxP${*'', ${*4', $fcha4*', $fcha* ', $fcha *', $fcha*', $*'', ${','c. $fcha{',4c. $fcha4',c. $fcha', c.  $ ',c.  $fcha',c.  $fcha','c.  D {c.a/2Label18{c.a/ >Q  Ld <d"ArialtSerifiPdaaaadaddG^^^^^^^^{\rtf1\ansi\ansicpg1252\deff0\deflang1033{\fonttbl{\f0\fswiss\fprq2\fcharset0 Arial;}} {\colortbl ;\red0\green0\blue0;} \viewkind4\uc1\pard\sl240\slmult1\cf1\f0\fs16 Therapist's Signature:\par } D {a/'33[prTable378{a/'3  L<}   D {a/40 rtField:18{a/40xy codes.\expndt  Ld <d"ArialtSerifxP{\rtf1\ansi\ansicpg1252\deff0\deflang1033{\fonttbl{\f0\fswiss\fprq2\fcharset0 Arial;}} {\colortbl ;\red0\green0\blue0;} \viewkind4\uc1\pard\sl240\slmult1\qc\cf1\f0\fs16 Therapy Date\par } D{043 rtField:2(. Z?G)#v@;?F8{043xy codes.\expndt  Miscellaneous ObjectsEd d"ArialtSerifxeMM/dd/yy D 4a/0 rtField:384a/0xy codes.\expndt  Ld <d"ArialtSerifxP{\rtf1\ansi\ansicpg1252\deff0\deflang1033{\fonttbl{\f0\fswiss\fprq2\fcharset0 Arial;}} {\colortbl ;\red0\green0\blue0;} \viewkind4\uc1\pard\sl240\slmult1\qc\cf1\f0\fs16 Proxy\par Code\par } D a/ 0 rtField:48a/ 0xy codes.\expndt  Ld <d"ArialtSerifxP{\rtf1\ansi\ansicpg1252\deff0\deflang1033{\fonttbl{\f0\fswiss\fprq2\fcharset0 Arial;}} {\colortbl ;\red0\green0\blue0;} \viewkind4\uc1\pard\sl240\slmult1\qc\cf1\f0\fs16 Begin\par Time\par } D a/0 rtField:58 a/0xy codes.\expndt  Ld <d"ArialtSerifxP{\rtf1\ansi\ansicpg1252\deff0\deflang1033{\fonttbl{\f0\fswiss\fprq2\fcharset0 Arial;}} {\colortbl ;\red0\green0\blue0;} \viewkind4\uc1\pard\sl240\slmult1\qc\cf1\f0\fs16 End\par Time\par } D a/0 rtField:68a/0xy codes.\expndt  Ld <d"ArialtSerifxP{\rtf1\ansi\ansicpg1252\deff0\deflang1033{\fonttbl{\f0\fswiss\fprq2\fcharset0 Arial;}} {\colortbl ;\red0\green0\blue0;} \viewkind4\uc1\pard\sl240\slmult1\qc\cf1\f0\fs16 Units\par (max of 5)\par } D a/'0 rtField:78a/'0xy codes.\expndt  Ld <d"ArialtSerifxP9{\rtf1\ansi\ansicpg1252\deff0\deflang1033{\fonttbl{\f0\fswiss\fprq2\fcharset0 Arial;}} {\colortbl ;\red0\green0\blue0;} \viewkind4\uc1\pard\sl240\slmult1\qc\cf1\expndtw-2\f0\fs15 Briefly describe activities, exercises and equipment used,\par as wellas progress toward IEP therapy goals.\expndtw0\fs16\par } D 403 rtField:88403xy codes.\expndt  Ld <d"ArialtSerifxP D 0 3  rtField:980 3xy codes.\expndt  Ld <d"ArialtSerifxP D 03  rtField:108 03xy codes.\expndt  Ld <d"ArialtSerifxP D 03  rtField:11803xy codes.\expndt  Ld <d"ArialtSerifxP D 0'3  rtField:1280'3xy codes.\expndt  Ld <d"ArialtSerifxP${a/'0 ${a/40 $fcha4a/0 $fchaa/ 0 $fcha a/0 $fchaa/0 $a/'0 ${0'3 $fcha{043 $fcha403 $fcha0 3  $ 03  $fcha03  $fcha0'3  D {344Label18{34 >Q  Ld <d"ArialtSerifiPdaaaadaddG^^^^^^^^{\rtf1\ansi\ansicpg1252\deff0\deflang1033{\fonttbl{\f0\fswiss\fprq2\fcharset0 Arial;}} {\colortbl ;\red0\green0\blue0;} \viewkind4\uc1\pard\sl240\slmult1\cf1\f0\fs16 Therapist's Signature:\par }