Oregon Health Plan uses this report from a speech-language pathologist to justify a speech-generating or augmentative communication device under fee-for-service prior authorization. The SLP summarizes the evaluation and device selection that support the request. The report is attached to the MSC 3971 prior authorization request that OHA reviews.
The evaluating speech-language pathologist completes the whole report. The requesting provider submits it with the prior authorization request, and the requesting, performing and referring providers must all be enrolled with OHP.
Download the current version from the source each time; forms change without notice.
Augmentative Communication Device Selection Summary Report
If your copy of the form is a fillable PDF, upload it once and Vero Documents fills it from the visit note and the chart, ready for you to review and sign. Download, print, or email the finished form, with the patient’s consent.
A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms and their requirements change without notice, so check the official page for the current version before you complete one.
Vero is not affiliated with, or endorsed by, the agencies and insurers listed here. Read our editorial policy.
A speech-language pathologist completes the Augmentative Communication Device Selection Summary Report. It summarizes the evaluation that justifies the speech-generating device being requested. The report is then attached to the fee-for-service prior authorization request submitted on the MSC 3971 or through the OHA Provider Portal.
OHA lists it among the supporting forms for fee-for-service prior authorization. When a member's services are covered by a coordinated care organization, OHA directs providers to follow that CCO's procedures instead, so check the member's enrollment before using the OHA process.