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Attach Client addressograph label or complete: Name: ___ DOB: ___ MAN: ___ Address: ___ ___ ___SEAMOUNT HEALTHCARE AGE RELATED REHABILITATION SERVICE APPLICATION FORM Applications will only be considered
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How to fill out age related rehabilitation referral

01
Obtain the referral form from the relevant healthcare provider or facility.
02
Fill out the patient's personal information such as name, address, contact number, and date of birth.
03
Provide details of the patient's medical history and current health condition.
04
Specify the type of rehabilitation services needed and any specific goals or outcomes to be achieved.
05
Include any relevant medical reports or test results to support the referral.
06
Sign and date the referral form before submitting it to the appropriate healthcare provider or facility.

Who needs age related rehabilitation referral?

01
Individuals who have suffered from injuries, accidents, or illnesses that have impacted their physical or cognitive abilities.
02
Elderly individuals who are experiencing age-related health issues such as decreased mobility, strength, or balance.
03
Patients recovering from surgery or medical procedures that require rehabilitation to regain functionality and improve quality of life.
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Age related rehabilitation referral is a process in which individuals are referred to rehabilitation services based on their age and specific needs to improve their physical, mental, or emotional well-being.
Healthcare professionals, social workers, or family members may be required to file an age related rehabilitation referral for an individual who may benefit from rehabilitation services.
Age related rehabilitation referral forms can be filled out by providing the individual's demographics, medical history, current health status, and specific rehabilitation needs.
The purpose of age related rehabilitation referral is to ensure that individuals receive appropriate rehabilitation services to improve their overall quality of life and independence.
Information such as the individual's age, medical conditions, functional limitations, rehabilitation goals, and recommended treatment plan must be reported on an age related rehabilitation referral.
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