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A completed Medical Necessity Prior Authorization form for an ABA therapy patient.

Source document used: Clinician's Clinical Progress & Authorization Note

Patient Intake and Treatment Plan - Confidential. Today is March 12, 2026. I am seeing Leo R. Sterling, born on September 15, 2019, regarding his continued Applied Behavior Analysis (ABA) requirements. Leo, residing at 442 Oakwood Drive, Springfield, IL 62704, exhibits significant developmental delays. During today's observation, we noted that Leo struggles with social engagement and verbal communication, specifically in peer-to-peer interaction settings. His primary caregiver, Sarah Sterling, confirmed that these behaviors have persisted since early 2024. Despite intensive speech therapy, progress remains stagnant in classroom environments. The treatment plan involves 25 hours per week of one-on-one therapy focused on functional communication training and social skill acquisition. We anticipate a review period of 90 days. His insurance provider is BlueCross BlueShield of Illinois, policy number BCBS-IL-8849200-X. Regarding his medical history, Leo has no known drug allergies but is currently managing minor asthma. His primary physician, Dr. Marcus Thorne, has reviewed the diagnostic assessment and agrees that the requested therapy is medically necessary for his long-term developmental success. I expect that he will achieve basic requesting skills within the first six weeks, provided consistent attendance is maintained. All sessions will be conducted at the Springfield Community Wellness Center. The billing address for the facility is 100 Main St, Suite 202, Springfield. Total requested service duration is from April 1, 2026, to June 30, 2026. Please expedite this request as the current authorization expires on March 31, 2026.