Get the free GENERAL PHYSICAL THERAPY REFERRAL FORM - Cone Health

GENERAL PHYSICAL THERAPY REFERRAL FORM Adams Farm 5817 High Point Rd. Greensboro, NC 27407 Phone: 336-218-0531 Fax: 336-218-0562 Brass field 3800 Robert Porches Way, Ste. 400 Greensboro, NC 27410

How to fill out general physical therapy referral

How to fill out general physical therapy referral:

1. Begin by obtaining the necessary referral form from your primary care physician or healthcare provider.
2. Fill in your personal information including your full name, date of birth, contact information, and insurance details.
3. Provide a detailed description of your current condition, injury, or reason for seeking physical therapy. Be specific about any pain, limitations, or functional impairments you are experiencing.
4. If you have any relevant medical history, such as previous surgeries, chronic conditions, or allergies, make sure to include this information on the referral form.
5. Indicate the preferred physical therapy clinic or facility where you would like to receive treatment. If you have not chosen a specific clinic, you can leave this section blank and allow your healthcare provider to guide you.
6. If your insurance requires prior authorization for physical therapy services, ensure that the referral form is complete with the necessary provider information, treatment codes, and anticipated number of therapy visits.
7. Finally, sign and date the referral form, ensuring that you have provided all the necessary information.

Who needs general physical therapy referral?

1. Individuals who have recently sustained an injury or undergone surgery that requires rehabilitation to regain movement, strength, or function.
2. Individuals with chronic conditions such as arthritis, fibromyalgia, or osteoporosis, who can benefit from physical therapy to manage pain, improve mobility, and enhance overall quality of life.
3. Patients with neurological disorders like stroke, multiple sclerosis, or spinal cord injuries, who need physical therapy to improve motor control and regain independence.
4. Athletes who require rehabilitation after sports-related injuries to recover and prevent further damage.
5. Individuals experiencing musculoskeletal issues such as back pain, neck pain, or joint problems that can be effectively treated through physical therapy interventions.
6. Patients preparing for or recovering from orthopedic surgeries, such as joint replacements or ligament repairs, who benefit from physical therapy to restore function and range of motion.

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What is general physical therapy referral?

A general physical therapy referral is a document that is prescribed by a healthcare practitioner to refer an individual to physical therapy for treatment or rehabilitation.

Who is required to file general physical therapy referral?

Healthcare practitioners, such as doctors or authorized medical professionals, are required to file general physical therapy referrals for their patients.

How to fill out general physical therapy referral?

To fill out a general physical therapy referral, the healthcare practitioner must include the patient's information, the reason for referral, any relevant medical history, and any specific instructions or requests for the physical therapist.

What is the purpose of general physical therapy referral?

The purpose of a general physical therapy referral is to provide a formal document that authorizes the patient to receive physical therapy services and ensures proper communication between the healthcare practitioner and the physical therapist.

What information must be reported on general physical therapy referral?

The general physical therapy referral should include the patient's name, contact information, relevant medical history, reason for referral, any specific treatments or interventions recommended by the healthcare practitioner, and any other pertinent information.