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EVANSVILLE PHYSICAL THERAPY PATIENT MEDICAL HISTORY FORM Name: Date of Birth: Date: Do you have any allergies to medications? Circle Yes or No Yes. No Have you or any immediate family member ever
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How to fill out stevensville physical therapy patient:

01
Start by providing your personal information such as your full name, date of birth, address, and contact information.
02
Next, provide your insurance information including the insurance company name, policy number, and any other relevant details.
03
Fill out the medical history section by accurately listing any pre-existing medical conditions, surgeries, or injuries you have had in the past.
04
Include a description of your current symptoms or the reason for seeking physical therapy. Be as detailed as possible to ensure the therapist understands your needs.
05
If you have any specific goals or expectations for physical therapy, make sure to mention them in the appropriate section.
06
Complete any additional forms or questionnaires that may be provided, such as a pain scale or functional assessment.
07
Sign and date the form to certify that the information provided is accurate and complete.

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Individuals who have suffered from musculoskeletal injuries or surgeries and require rehabilitation.
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Stevensville physical therapy patient is an individual who is receiving physical therapy services at a facility in Stevensville.
The healthcare provider or facility providing the physical therapy services is required to file the patient information.
The provider must accurately document the patient's information such as name, contact details, medical history, treatment plan, progress notes, and any other relevant information.
The purpose of documenting the patient information is to track the progress, ensure optimal care, and comply with legal and regulatory requirements.
Basic patient demographics, medical history, treatment plan, progress notes, and any relevant reports or test results must be reported.
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