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PT/OT Treatment Request Clinical Worksheet Lymphedema ManagementOrdering ProviderPatient/Member MONUMENT requests, please fax this completed document along with medical records, imaging, tests, etc.

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How to fill out ptot treatment request clinical

01

To fill out a PTOT treatment request clinical form, follow these steps: 1. Start by entering the patient's personal information, including their name, address, and date of birth. 2. Provide details about the patient's medical history, including any previous injuries or treatments related to their condition. 3. Specify the current diagnosis and provide documentation or test results supporting the diagnosis. 4. Describe the recommended PTOT treatment plan, including the type of therapy, frequency, and duration. 5. If necessary, include any special accommodations or equipment required for the treatment. 6. Include the healthcare provider's information, such as their name, contact details, and professional license number. 7. Lastly, review the completed form for any errors or missing information before submitting it to the appropriate authority.

Who needs ptot treatment request clinical?

01

PTOT treatment request clinical form is needed by individuals who require physical and/or occupational therapy for a specific medical condition or injury. This includes patients who have been diagnosed with musculoskeletal disorders, neurological disorders, chronic pain conditions, or those recovering from surgeries or accidents. The form is usually filled out by healthcare providers, such as physicians, physiotherapists, or occupational therapists, who are recommending or requesting the therapy on behalf of their patients.

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