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Name Date of Birth Today's Date Height ft. in. Weight lbs. Upper Extremity Functional Scale We are interested in knowing whether you are having any difficulty with the activities listed below because

How to fill out upper extremity functional scale

How to fill out CA Rozina and Smith Physical Therapy Upper

1. Obtain the CA Rozina and Smith Physical Therapy Upper form from the clinic or website.
2. Fill in your personal details, including your full name, date of birth, and contact information.
3. Provide your insurance information, including the provider name, policy number, and group number if applicable.
4. Detail your medical history, including any current conditions or injuries and previous treatments.
5. List any medications you are currently taking or have taken recently.
6. Sign and date the form, confirming that all information is accurate and complete.
7. Submit the form either in person at the clinic or electronically via the clinic's online submission portal.

Who needs CA Rozina and Smith Physical Therapy Upper?

1. Individuals recovering from injuries or surgeries.
2. Patients suffering from chronic pain conditions.
3. People looking to improve mobility or physical function.
4. Athletes needing rehabilitation after sports-related injuries.
5. Anyone seeking physical therapy for conditions diagnosed by a healthcare provider.

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What is CA Rozina and Smith Physical Therapy Upper?

CA Rozina and Smith Physical Therapy Upper is a specialized physical therapy practice that provides rehabilitation and therapeutic services for patients experiencing physical impairments or injuries. It focuses on upper body treatments.

Who is required to file CA Rozina and Smith Physical Therapy Upper?

Individuals who are seeking physical therapy services at CA Rozina and Smith are typically required to file relevant paperwork, including new patient forms and insurance information, to initiate treatment.

How to fill out CA Rozina and Smith Physical Therapy Upper?

To fill out CA Rozina and Smith Physical Therapy Upper forms, patients should provide personal information, insurance details, medical history, and a description of their physical condition or concern. It's important to complete all required fields honestly.

What is the purpose of CA Rozina and Smith Physical Therapy Upper?

The purpose of CA Rozina and Smith Physical Therapy Upper is to assist patients in improving their physical function, managing pain, and promoting recovery through specialized therapy techniques tailored to upper body conditions.

What information must be reported on CA Rozina and Smith Physical Therapy Upper?

Patients must report their personal identification information, insurance coverage details, medical history including past injuries or surgeries, current medications, and any specific issues related to their upper body that require therapy.