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1 Todd C. Battalion, MD, MS Syracuse Orthopedic Specialists, PC Patient name: Date: PHYSICAL THERAPY PRESCRIPTION AND PROTOCOL: Standard Total Shoulder Replacement GENERAL GUIDELINES 1. Limit external
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How to fill out a physical therapy prescription:

01
Start by entering the patient's personal information, including their name, date of birth, address, and contact information.
02
Specify the referring physician's details, such as their name, practice name, contact information, and any relevant identification numbers.
03
Indicate the date of the prescription and ensure it is valid and current.
04
Describe the patient's diagnosis or condition that requires physical therapy treatment. Include any relevant medical history or limitations that the therapist should be aware of.
05
Specify the frequency and duration of the physical therapy sessions. This could include the number of sessions per week or the total number of sessions authorized.
06
Include any special instructions or restrictions for the physical therapist. This could involve specific treatment goals or techniques to be used during the sessions.
07
Add any necessary copies or attachments, such as X-ray reports or medical notes, that support the need for physical therapy.
08
Review the completed prescription for accuracy and legibility before signing and dating it.
09
Keep a copy for your records and provide the original prescription to the patient or their caregiver to take to the physical therapy facility.

Who needs a physical therapy prescription:

01
Individuals recovering from surgery or injury: Physical therapy can help rehabilitate and strengthen the affected areas, promoting a faster and more complete recovery.
02
Patients with chronic pain or medical conditions: Physical therapy can provide relief and improve functionality for individuals suffering from conditions like arthritis, fibromyalgia, or chronic back pain.
03
Athletes: Physical therapy can aid in injury prevention, optimize performance, and assist with rehabilitation after sports-related injuries.
04
Elderly individuals: Physical therapy can help improve balance, coordination, and mobility, reducing the risk of falls and enhancing overall quality of life.
05
Children with developmental delays or disabilities: Physical therapy can assist in promoting motor skills, coordination, and physical independence.
06
Individuals with neurological conditions: Physical therapy can benefit those with conditions like stroke, multiple sclerosis, or Parkinson's disease by improving mobility and overall functioning.
In conclusion, filling out a physical therapy prescription involves gathering patient and physician information, providing detailed instructions for treatment, and ensuring the prescription is accurate and valid. Physical therapy can benefit a wide range of individuals, including those recovering from injury or surgery, individuals with chronic conditions, athletes, the elderly, children with developmental delays, and those with neurological conditions.
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Physical therapy prescription is a written order from a licensed healthcare provider for a patient to receive physical therapy services.
Physical therapy prescriptions are typically issued by physicians, but other healthcare providers such as nurse practitioners, physician assistants, and chiropractors may also be authorized to prescribe physical therapy.
Physical therapy prescriptions should include the patient's name, date of birth, diagnosis, recommended treatment plan, frequency of sessions, and duration of treatment.
The purpose of a physical therapy prescription is to provide guidance to the physical therapist on the patient's condition, treatment goals, and recommended interventions.
The physical therapy prescription should include the healthcare provider's name, contact information, NPI number, and signature.
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