Get the free PHYSICAL THERAPY REFERRAL FORM - spiveyortho.com

C. Mark Shiva, M.D. J. Casey Shiva, MD Eric Carney, PT, DPT, Dip Osteopathic, Cert. DN, Cert. VRS3301 East First Street, Suite A Visalia, Georgia 30474 P: (912)5378889 F: (912)5388485 www.spiveyortho.comBailey

How to fill out physical therapy referral form

How to fill out physical therapy referral form

1. To fill out a physical therapy referral form, follow the steps below:
2. Start by providing the patient's personal information, such as their full name, date of birth, address, and contact details.
3. Include the referring physician's information, including their name, address, and contact details.
4. Specify the reason for referral and the diagnosis, if known.
5. Indicate the desired physical therapy services by selecting the appropriate checkboxes or writing them down.
6. Mention any relevant medical history or previous treatments that may impact the physical therapy plan.
7. Provide any additional comments or instructions that the therapist should consider while evaluating and treating the patient.
8. Ensure that all the required fields are completed accurately and legibly.
9. Lastly, sign and date the referral form to validate the information provided.
10. Make a copy of the referral form for your records and submit it to the physical therapy clinic.
11. Note: It is advisable to consult the specific guidelines or requirements of the physical therapy clinic or insurance provider to ensure compliance.

Who needs physical therapy referral form?

1. Physical therapy referral forms are typically required for individuals who need to receive physical therapy services.
2. The following individuals may need a physical therapy referral form:
3. - Patients who have been advised by their primary care physician or specialist to seek physical therapy.
4. - Individuals who have suffered an injury or undergone a surgical procedure that requires rehabilitation through physical therapy.
5. - Athletes or sports enthusiasts who need sports-specific physical therapy.
6. - Patients with chronic pain or musculoskeletal conditions that can benefit from physical therapy treatment.
7. - Individuals seeking physical therapy for preventive measures or to improve physical strength and mobility.
8. It's important to note that the specific requirements for a physical therapy referral form may vary depending on the healthcare system, insurance provider, or the policies of the physical therapy clinic.

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What is physical therapy referral form?

Physical therapy referral form is a medical document that allows healthcare providers to refer a patient to a physical therapist for treatment.

Who is required to file physical therapy referral form?

Healthcare providers such as doctors, nurse practitioners, and physicians assistants are required to file physical therapy referral forms.

How to fill out physical therapy referral form?

To fill out a physical therapy referral form, healthcare providers need to provide patient information, reason for referral, diagnosis, and any specific treatment recommendations.

What is the purpose of physical therapy referral form?

The purpose of physical therapy referral form is to facilitate communication between healthcare providers and physical therapists to ensure appropriate treatment for the patient.

What information must be reported on physical therapy referral form?

Information such as patient demographics, current medical condition, referral reason, and any relevant medical history must be reported on the physical therapy referral form.