EJ Therapy

OTR/PT/SP Therapy Log Sheet

District:________________________	Building: _________________________

Therapist:_______________________	Month/Year:_______________________

STUDENT	SCHEDULE	DATES/DURATION
TOTAL FOR EACH DAY
TOTAL TREATMENT HOURS

A= Absent FT= Field Trip TA=Therapist Absent NS= No School T=Testing NA=child not available (party, assembly, etc)

DATE	EVALUATIONS	EVAL	TREAT
Documentation (#) .25
Progress reports/interim (#) x .25
1 Hour Minimum x .5
TOTALS
TOTAL TREATMENT HOURS FROM ABOVE
TOTAL HOURS BILLED

Student Material/Supplies:

EJ Therapy

OTR/PT/SP Therapy Log Sheet

District:________________________	Building: _________________________

Therapist:_______________________	Month/Year:_______________________

STUDENT	SCHEDULE	DATES/DURATION
TOTAL FOR EACH DAY
TOTAL TREATMENT HOURS

A= Absent FT= Field Trip TA=Therapist Absent NS= No School T=Testing NA=child not available (party, assembly, etc)

DATE	EVALUATIONS	EVAL	TREAT
Progress reports/interim (#) x .25
1 Hour Minimum x .5
TOTALS
TOTAL TREATMENT HOURS FROM ABOVE
TOTAL HOURS BILLED

Student Material/Supplies: