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PHYSICAL THERAPIST/PHYSICAL THERAPIST ASSISTANT TERMINATION OF SUPERVISION Termination of a supervision agreement must be reported to the Board within 10 days of the termination. Please be aware,
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How to fill out pt-pta termination supervision agreement

01
Obtain a copy of the PT-PTA termination supervision agreement form from the appropriate authority or organization.
02
Read through the form carefully to understand the requirements and expectations outlined.
03
Fill in the necessary personal information, such as your name, address, and contact details.
04
Provide information about the PT (Physical Therapist) and PTA (Physical Therapist Assistant) involved in the termination supervision agreement.
05
Clearly state the effective date of the supervision termination agreement.
06
Make sure to include any additional terms or conditions agreed upon by both parties.
07
Review the completed form for accuracy and make any necessary corrections.
08
Sign the termination supervision agreement form and have the PT and PTA also sign it.
09
Submit the completed form to the appropriate authority or organization for processing and approval.
10
Keep a copy of the filled-out termination supervision agreement for your records.

Who needs pt-pta termination supervision agreement?

01
PTs (Physical Therapists) and PTAs (Physical Therapist Assistants) who have a professional working relationship and wish to terminate their supervision agreement.
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The pt-pta termination supervision agreement is a legal document that outlines the terms and conditions surrounding the termination of a physical therapy-patient relationship and the supervision of the patient's ongoing care.
Physical therapists are required to file pt-pta termination supervision agreements.
The pt-pta termination supervision agreement must be filled out with information regarding the patient, the physical therapist, the reason for termination, the supervision plan for ongoing care, and signatures from both parties.
The purpose of the pt-pta termination supervision agreement is to ensure a smooth transition for the patient's care after the termination of the physical therapy services.
Information such as patient details, therapist details, reason for termination, supervision plan, and signatures must be reported on the pt-pta termination supervision agreement.
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