Follow the steps to accurately complete the form:

1. Click ‘Get Form’ button to obtain the Stein Ancillary Services form and open it in the editor.
2. Enter today's date and the assessment reference date (ARD) at the top of the form. Ensure you double-check these dates for accuracy.
3. In the Patient Name field, provide the full name of the individual receiving therapy services.
4. Select the Assessment Type by circling the relevant option, such as 5, 14, 30, 60, 90 days, or COT (Change of Therapy) and EOT (End of Therapy).
5. Fill in the Therapy Coordinator's name to identify the person overseeing the therapy sessions.
6. For Speech-Language Pathology, enter the total individual minutes, concurrent minutes with one other resident, and group minutes in their respective fields for the last 7 days.
7. Record co-treatment minutes separately in the designated area for Speech-Language Pathology.
8. Complete the section detailing how many days therapy was administered for at least 15 minutes daily within the last 7 days.
9. Provide the therapy start date and therapy end date, entering dashes if therapy is ongoing.
10. Repeat steps 6 to 9 for Occupational Therapy and Physical Therapy sections.
11. Finally, enter the distinct calendar days of therapy received across all types of therapy for at least 15 minutes over the past 7 days.
12. Once you have completed all sections, save your changes, download a copy of the form, print it, or share it as needed.

Complete the Stein Ancillary Services online today and ensure accurate documentation of therapy services.