2019 EviCore Healthcare PT OT Therapy Intake Form: Neurological Conditions-2025

1. Click ‘Get Form’ to open the 2019 EviCore Healthcare PT OT Therapy Intake Form in our editor.
2. Begin by filling in the patient’s personal information, including First Name, Last Name, Date of Birth, and contact details. Ensure accuracy as this information is crucial for processing.
3. In the 'Provider' section, enter the provider's details such as name, specialty, and contact information. This helps streamline communication between healthcare providers.
4. Complete the 'Administrative' section by selecting the type of service requested (Physical or Occupational Therapy) and providing relevant diagnosis codes and descriptions.
5. For the 'Patient Reported/Standardized Assessment' section, select appropriate measures used to assess mobility and health status. Input scores for both initial and follow-up assessments where applicable.
6. Review all entered information for completeness before submitting. Utilize our platform’s features to save your progress or share it with colleagues for review.

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