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DRIVER REHAB PROGRAM 414 Pauli Pike Tavern, PA 19355 TEL 484.596.6000 FAX 484.596.5449 mainlinehealth.org/driverrehabDRIVER REHAB PROGRAM REFERRAL FORM PATIENT DEMOGRAPHICS *** All fields required
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How to fill out driver rehab program referral
How to fill out driver rehab program referral
01
Contact the driver rehab program provider to request a referral form
02
Fill out the referral form completely and accurately with the client's information
03
Include any relevant medical information or history that may be beneficial for the program
04
Submit the completed referral form to the driver rehab program provider either electronically or by mail
Who needs driver rehab program referral?
01
Individuals who have experienced a medical condition or injury that may impact their ability to drive safely
02
Seniors who may need a refresher or assessment to maintain safe driving skills
03
Individuals with disabilities that may require adaptive equipment or techniques for driving
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What is driver rehab program referral?
Driver rehab program referral is a process where individuals who have been identified as needing driver rehabilitation services are referred to appropriate programs for evaluation and training to improve their driving skills.
Who is required to file driver rehab program referral?
Healthcare professionals, such as doctors or occupational therapists, are typically required to file driver rehab program referral for their patients who may benefit from the program.
How to fill out driver rehab program referral?
Driver rehab program referral can be filled out by healthcare professionals by providing necessary information about the patient's medical history, driving abilities, and reason for referral.
What is the purpose of driver rehab program referral?
The purpose of driver rehab program referral is to ensure that individuals who may have challenges with driving receive proper evaluation and training to improve their safety on the road.
What information must be reported on driver rehab program referral?
Driver rehab program referral must include the patient's medical history, current driving abilities, reason for referral, and any relevant information that may help in assessing the individual's needs.
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