Get the free Occupational Therapy Referral Form

This form is intended for making referrals for children to receive Occupational Therapy services at the Resiliency Center for Families and Children, part of the Unified Clinics at Western Michigan University. It collects necessary information about the child, caregiver, referring person, insurance details, and treatment goals to facilitate the referral process.

How to fill out occupational formrapy referral form

How to fill out occupational formrapy referral form

1. Begin by writing your personal information at the top of the form, including your name, date of birth, and contact details.
2. Fill out the referral date and the name of the referring provider or physician.
3. Describe the reason for the referral clearly, including any specific concerns or diagnoses.
4. Indicate any previous treatments or therapies the patient has undergone that are relevant to occupational therapy.
5. List the specific goals you hope to achieve through occupational therapy.
6. Provide any additional information or medical history that may assist the occupational therapist.
7. Review the completed form for accuracy and completeness before submission.

Who needs occupational formrapy referral form?

1. Individuals with physical disabilities, injuries, or conditions affecting their ability to perform daily tasks.
2. People recovering from surgery who require assistance in regaining functionality.
3. Children with developmental delays or learning disabilities that affect their daily activities.
4. Elderly individuals who may need support to maintain independence in their daily living activities.
5. Anyone experiencing challenges due to mental health issues that impact their occupational performance.

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What is occupational formrapy referral form?

The occupational therapy referral form is a document used to request occupational therapy services for a patient, detailing the individual's needs, diagnosis, and treatment goals.

Who is required to file occupational formrapy referral form?

Healthcare providers, such as doctors or specialists, are required to file the occupational therapy referral form when they believe that a patient would benefit from occupational therapy services.

How to fill out occupational formrapy referral form?

To fill out the occupational therapy referral form, a provider should include patient information, diagnosis, relevant medical history, specific therapy needs, and any treatment goals or outcomes expected from the therapy.

What is the purpose of occupational formrapy referral form?

The purpose of the occupational therapy referral form is to formally request occupational therapy evaluation and treatment for a patient, ensuring proper communication between healthcare providers regarding the patient's care.

What information must be reported on occupational formrapy referral form?

The form must include patient contact details, physician's information, diagnosis, medical history, assessment details, and specific occupational therapy needs or goals.