The DMS-640 is the form utilized to obtain the PCP referral and the written prescription for therapy services for any beneficiary under the age of 21 years.
Instructions for completion of form DMS-640 are located on the back of the form. The initial referral and the initial prescription must be obtained on two separate DMS 640 forms.
After the initial referral using the form DMS-640 and initial prescription utilizing a separate form DMS-640, subsequent referrals and prescriptions for continued therapy may be made using the same DMS-640.
>> View or print form DMS-640
Sections 214.000 E & 214.220 Arkansas Medicaid Provider Manual
Question: What are the requirements for the treatment plan (plan of care)?
A treatment plan or plan of care (POC) for the prescribed therapy must be developed and signed by providers credentialed and licensed in the prescribed therapy or by a physician. The plan must also include goals that are functional, measurable and specific for each individual client.
Sections 214.000F and 204.000 A 3 Arkansas Medicaid Provider Manual
When performing Oral 