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Nal Therapy Questions: (888) 343-3547 FHP members are allowed 20 PT and 20 OT visits annually. Only credentialed therapy providers and physiatrists will be approved. Effective 10/1/2011, Fidelis Care members will have a 20 visit limit annually This form will be required for all requests of therapy and incomplete or illegible forms will only delay determination of request. Member Name: Fidelis Member ID #: Date of Birth: Speech Therapy (SP), Physical Therapy (PT) / Occupational Therapy (OT) Serv.

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