____ ____ ___ Florida Department of Education Bureau of Exceptional Education and Student Services Considerations for Educationally Relevant Therapy OCCUPATIONAL AND PHYSICAL THERAPY SUMMARY SHEET Student: D.O.B.: School District: ESE Program(s): Related Service(s): Occupational Therapy Physical Therapy Points Sources of Information and Additional Comments Personal Care Mobility Student Profile Gross Motor Fine Motor/Visual Motor Sensory Processing Total Points: Completed by: Date: To be completed at ... ____ Occupational therapy is indicated. ____ Physical therapy is indicated.
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