Get Spl - West Virginia Department Of Education

Filling out the SPL – West Virginia Department Of Education form is essential for documenting occupational therapy services. This guide provides clear, step-by-step instructions to help users complete the form accurately and efficiently.

Follow the steps to fill out the SPL form correctly.

1. Press the ‘Get Form’ button to access the form and open it in your editor.
2. Begin by entering the Medicaid number in the designated field.
3. Fill in the last name and first name of the person receiving services.
4. Enter the WVEIS number associated with the individual.
5. Input the diagnosis code in the respective field.
6. Provide the date of birth for the individual receiving therapy.
7. Select the county where the services are provided.
8. For each procedure, record the beginning and ending dates, procedure code, and units in the respective sections labeled 1, 2, and 3.
9. In the Provider Name field, enter the name of the occupational therapy provider.
10. Ensure that a physician’s authorization is documented and included in the service plan provided.
11. Choose the appropriate procedure codes from the listed options for occupational therapy and ensure to follow guidance on the use of evaluation codes.
12. Complete the date, start time, and end time fields for the therapy sessions.
13. After entering all necessary information, review the form for accuracy.
14. Save your changes, and use the options to download, print, or share the completed form as necessary.

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