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Travis G. Mark, M.D. 590 Jakarta Way Salt Lake City, UT 84108 Tel: (801) 5877109 Fax: (801)5877112Lic. # 82347971205Physical Therapy Prescription Tibial Tubercle Osteotomy Patient Name:Today's Date:DX:

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How to fill out tto specific pt protocol

01

Gather all necessary information such as patient's name, date of birth, medical history, and reason for needing the specific PT protocol.

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