Billing and Coding: Outpatient Physical and Occupational Therapy Services 2025

1. Click ‘Get Form’ to open it in the editor.
2. Begin by filling out the applicant's personal information, including first name, middle name, last name, and any previous names used. This section is crucial for identification purposes.
3. Authorize the college/university to share your information with NBCOT by signing and dating the form. This consent is necessary for processing your application.
4. The Program Director should complete their section by providing details about the occupational therapy program, including the department, college/university name, address, and contact information.
5. Document clinical/fieldwork experience by indicating the number of hours completed in both full-time and part-time settings. Specify types of experiences such as physical disabilities or pediatrics.
6. Confirm whether the applicant has completed clinical/fieldwork under supervision. If not, provide an explanation on the reverse side of the form.
7. Ensure that all required fields are filled accurately before adding an official stamp or seal from the institution.
8. Finally, sign and date the form as a Program Director to attest that all responses are complete and accurate before mailing it to NBCOT.

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