PT/OT Referral Form

PT/OT Referral Form - (Forms/Publications)
Document Information
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Title PT/OT Referral Form (108 KB DOC)
Description

Attending Providers use this form to refer injured workers for physical or occupational therapy to progressively increase activity and exercise, or activity tolerance, develop home or self-care programs, and perform work activity conditioning. Explains to therapists your specific requests and expected follow-up therapy reports.

Detail
Form number F252-099-000
Availability
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Keywords attending provider, referral, therapy
Languages English
Valid dates 10-2013
Contact information Managing Injured Workers' Claims
Claims for Job Injuries
Web pages For Medical Providers

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