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Physician's Order for Therapy

Lissa Power-deFur, PhD, CCC-SLP

November 16, 2015

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Question

I am a school-based SLP. If I receive a doctor's order for therapy for a student, do I have to provide it?

Answer

No, you do not. The provision of speech-language services in schools is an educational decision, not a medical decision.  The physician has not done the assessment that you have done as a speech-language pathologist.  That physician does not have the ability to observe in the classroom and relate the speech-language impairment back to the educational environment.  By federal law, the decision can only be made by the eligibility team and cannot be made by a single individual, including the child's physician.  However, the physician can serve as an invited member of the team.  Wouldn’t it be great, as we are entering the era of interprofessional practice, if physicians, nurse practitioners, and physician assistants had the time to come and participate in meetings, or even participate by phone?  Certainly, the medical report should be considered by the team, but there is no mandate that it should be followed.  This can be challenging in some areas, because doctors’ orders do apply in another venue (i.e. insurance).  Whether private insurance or public insurance, like Medicaid, the doctor's order is critical.  If you are billing Medicaid for children that you serve in schools, your state Medicaid office is most likely going to require the physician’s order; but that physician’s order does not make the child eligible.  It is just a requirement to meet the Medicaid eligibility requirements.

This Ask the Expert is an excerpt from an article/text course on this topic - view it in its entirety here.


lissa power defur

Lissa Power-deFur, PhD, CCC-SLP

Lissa Power-deFur, PhD, CCC-SLP, ASHA-F serves as the communication sciences and disorders graduate program director at Longwood University, where she teaches a course in ethics and professional issues. Lissa received her bachelor’s, master’s, and doctoral degrees in speech-language pathology at the University of Virginia.  She currently serves on the ASHA Board of Directors as Vice President of Standards and Ethics in Speech-Language Pathology.  Previously, she has served the profession in her state association and on various ASHA boards and committees, including the ASHA Board of Ethics.  She has provided a number of professional development programs on ethical decision-making.  


Related Courses

Addressing Ethical Challenges Associated with Serving Children with Feeding and Swallowing Disorders in Schools
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This is Part 1 of a two-part series. This course will review the science of decision-making and how factors such as bias, cognitive dissonance, willful blindness, and “group think” may have an adverse influence on our ability to make thoughtful, well-informed decisions, including ethical decisions. Strategies that can minimize the influence of these factors and create more positive, achievable outcomes will be discussed.

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