Get the free PHYSICAL / OCCUPATIONAL THERAPY REFERRAL

MARIE HERRING, DPT, LAT, ATC MELANIE HERRING, PTA EMILY FORGES, LAT, ATC1301 East M Street Torrington, WY 82240 3075325355 FAX 3075325455 www.northplattept.comQUINN CARROLL, MST TARA NICOLAS, PTA

How to fill out physical occupational formrapy referral

How to fill out physical occupational formrapy referral

1. Obtain the physical occupational therapy referral form from your physician or healthcare provider.
2. Fill out the patient information section including your name, date of birth, address, and insurance information.
3. Provide information about your medical history, current symptoms, and any relevant past treatments.
4. Clearly state the reason for seeking physical occupational therapy and any specific goals you hope to achieve.
5. Make sure the form is signed and dated by both you and your referring healthcare provider.

Who needs physical occupational formrapy referral?

1. Individuals who are advised by their healthcare provider to undergo physical occupational therapy for rehabilitation or treatment.

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What is physical occupational therapy referral?

Physical occupational therapy referral is a document that is used to refer a patient to a physical therapist or occupational therapist for treatment.

Who is required to file physical occupational therapy referral?

A medical doctor, nurse practitioner, or physician assistant is required to file a physical occupational therapy referral.

How to fill out physical occupational therapy referral?

To fill out a physical occupational therapy referral, the referring healthcare provider must include the patient's information, reason for referral, and any specific treatment goals.

What is the purpose of physical occupational therapy referral?

The purpose of a physical occupational therapy referral is to provide patients with access to specialized therapy services to improve physical and occupational functioning.

What information must be reported on physical occupational therapy referral?

The information reported on a physical occupational therapy referral includes the patient's name, date of birth, medical history, reason for referral, and any relevant diagnostic results.