Get the free Paediatric Physiotherapy Referral Form - heartofengland nhs

Pediatric Physiotherapy Referral Form Please print and complete in black ink. Forms lacking adequate detailed information will delay appropriate next steps for this child. We suggest that professionals

How to fill out paediatric physiotherapy referral form

How to Fill Out Paediatric Physiotherapy Referral Form?

1. Start by providing personal information: Begin filling out the referral form by providing the patient's full name, date of birth, address, and contact details. Include any relevant insurance information if applicable.
2. Specify the referring healthcare professional: Clearly state the name, contact information, and credentials of the healthcare professional making the referral.
3. Outline the reason for referral: Indicate the specific reason why paediatric physiotherapy is being sought. Provide a detailed description of the child's condition or symptoms that require physiotherapy intervention.
4. Medical history: Fill out the section dedicated to the child's medical history. Include any relevant information such as previous diagnoses, surgeries, or ongoing medical conditions. This will help the physiotherapist tailor their treatment plan accordingly.
5. Current medications: List any medications the child is currently taking, including dosage and frequency. Mention any allergies or adverse reactions to medications if applicable.
6. Include relevant assessments or test results: Attach any recent assessment reports or test results that may assist in understanding the child's condition better. This could include X-rays, MRI scans, blood test results, or any other relevant medical documentation.
7. Goals and expectations: Clearly express the goals and expectations for physiotherapy treatment. Describe the desired outcomes and improvements that are expected from the therapy sessions.
8. Additional notes: Use this section to provide any additional information or specific instructions for the physiotherapist. This may include details about the child's daily routine, challenges faced at school or home, or any specific concerns regarding the treatment process.

Who Needs Paediatric Physiotherapy Referral Form?

1. Children with physical impairments or developmental delays: Any child who displays physical impairments, such as difficulty with mobility, coordination, or balance, may require paediatric physiotherapy. Similarly, children with developmental delays that affect their gross motor skills can benefit from physiotherapy intervention.
2. Post-operative rehabilitation: Children who have undergone surgeries, such as orthopedic procedures or neurosurgeries, may require physiotherapy for proper rehabilitation and optimal recovery.
3. Chronic conditions or diseases: Paediatric physiotherapy is often necessary for children with chronic conditions like cerebral palsy, muscular dystrophy, or spina bifida. These conditions require lifelong management, and physiotherapy plays a vital role in maintaining and improving functional abilities.
4. Sports injuries: Children involved in sports or physical activities are susceptible to injuries. Paediatric physiotherapy can aid in the recovery process, enhancing healing, and preventing further complications.
5. Developmental delays: Children with delayed milestones or developmental delays may require paediatric physiotherapy to help them achieve age-appropriate physical skills and milestones.
6. Musculoskeletal conditions: Any child experiencing musculoskeletal issues such as back pain, joint pain, or postural problems may benefit from paediatric physiotherapy to alleviate pain, improve mobility, and enhance overall well-being.

It is important to consult with a healthcare professional or a paediatrician to determine if paediatric physiotherapy is needed and to obtain a referral form if required.

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What is paediatric physiotherapy referral form?

Paediatric physiotherapy referral form is a medical document that is used to refer children to physiotherapy services for assessment and treatment of physical issues.

Who is required to file paediatric physiotherapy referral form?

Paediatric physiotherapy referral form can be filed by pediatricians, family doctors, or other healthcare providers who identify the need for physiotherapy intervention in children.

How to fill out paediatric physiotherapy referral form?

Paediatric physiotherapy referral form is typically filled out by providing the child's information, the reason for referral, any relevant medical history, and the healthcare provider's contact information.

What is the purpose of paediatric physiotherapy referral form?

The purpose of paediatric physiotherapy referral form is to facilitate the communication between healthcare providers and physiotherapists to ensure appropriate assessment and treatment for children.

What information must be reported on paediatric physiotherapy referral form?

Paediatric physiotherapy referral form must include the child's name, date of birth, reason for referral, relevant medical history, and the healthcare provider's contact information.