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226 ST. HWY 585 P.O. BOX 928 GUIDANCE, WY 82729 307.283.3516 FAX: 307.283.3515VERONICA KRAMER, P.ALICIA SCHOENBERG, P.T.A. KELSEY WILLIAMS, P.T.A.PHYSICAL THERAPY REFERRAL Patients Name: ___ Date
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01
Start by providing your personal information such as name, address, contact number, etc.
02
Fill out the medical history section including any previous injuries or surgeries.
03
Provide information on your current physical condition and any symptoms you are experiencing.
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Follow any specific instructions provided by the healthcare provider or clinic.
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Who needs north platte physical formrapyphysical?
01
Individuals who require physical therapy services from North Platte area clinics or healthcare providers.
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What is north platte physical formrapyphysical?
North Platte physical therapy is a type of rehabilitation that focuses on improving physical function and mobility.
Who is required to file north platte physical formrapyphysical?
Patients who are receiving physical therapy services in North Platte are required to file the form.
How to fill out north platte physical formrapyphysical?
The form can be filled out by providing personal information, insurance details, medical history, and the reason for seeking physical therapy.
What is the purpose of north platte physical formrapyphysical?
The purpose of the form is to document the patient's information, treatment plan, progress, and any updates in their physical therapy sessions.
What information must be reported on north platte physical formrapyphysical?
The form must include the patient's name, contact information, insurance details, medical history, current health issues, and treatment goals.
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