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Physical Therapy order
|
|
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Ordered PT Treatment
|
|
|
Radiology
• • •
|
Radiology Comments
|
|
Medical equipment & supplies
|
|
|
Patient Education
|
|
|
Referrals
|
Referral Comments
|
|
PT Recommendations
|
|
|
Follow-up appointment
|
|
|
Procedures
• • •
|
Medical Necessity for TPI
|
|
Procedure:
|
|
|
Neurological Studies Recommendation
|
|
|
Outcome assessment goal
|
|
|
Outcome assessment Review Recommendations:
|
|
|
Prognosis
|
|
|
Casual Relationship
|
|
|
Attestation
|
|
