26198 Script Pad Front - Preferred Physical Therapy 2025

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  1. Click ‘Get Form’ to open it in the editor.
  2. Begin by entering the appointment time and date at the top of the form. This ensures that all necessary details are captured for scheduling.
  3. In the 'Treatment Prescription' section, fill in the patient's name, diagnosis, and any medical precautions that need to be noted.
  4. Specify the type of therapy required (PT/OT) and indicate how many visits per week are needed along with the duration in weeks.
  5. For treatment evaluations, check off any modalities or procedures that apply from the provided list, ensuring comprehensive care is documented.
  6. Complete any additional notes regarding pelvic health or other specific treatments as necessary.
  7. Finally, sign and date the form at the bottom to certify that these services are medically necessary for the patient's plan of care.

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