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No Contraindications/Consent to Treat?(Required)
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Future Care as Needed (*DC Only)
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PLAN OF CARE
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Date Established
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# of Visits
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# of Weeks
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Reassessment (Visit #)
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Short Term Goals
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Goal #1
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Goal Status
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Goal #2
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Goal Status
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Goal #3
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Goal Status
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Notes
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Long Term Goals
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Goal #1
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Goal Status
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Goal #2
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Goal Status
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Goal #3
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Goal Status
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Notes
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PROCEDURES TO BE USED
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Manual Therapies
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Additional manual therapies may include:
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Therapeutic Exercises
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Exercises will include:
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Therapeutic Activities
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Activities will include:
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Home Exercise Program
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Additional Procedures
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List Additional Procedures Here:
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