This paper outlines the clinical reasoning process used to guide decisions on the provision of occupational therapy services in the Wake County Public School System in North Carolina. The process is based on a theoretical framework derived from occupational therapy theory and public law. Benefits of using the clinical reasoning process include (a) increased consistency of decision making among therapists; (b) increased appropriateness of decisions regarding whether a student needs educationally based occupational therapy services, what type of occupational therapy service would meet the student’s need, and how often this service should be provided; and (c) improved ability of therapist to articulate to all those involved with a student the reasoning behind decisions to provide educationally based occupational therapy services. The schematic diagrams that depict this process provide a useful tool for therapists with varied work experiences entering school-based practice.