pt - ot prescription front r11-15 · 2016. 9. 23. · fluidotherapy ice-heat iontophoresis...
TRANSCRIPT
PT/OT Prescription date:____________________
patient: ______________________________ phone: ________________________
diagnosis: _____________________________________________________________
frequency & duration
therapist discretion
1 2 3 4 5 days/week (circle one)
number of weeks: ______
comments / precautions______________________________________________________________________________________________________
services offered
evaluationsbalance programchronic pain functional capacity evaluationpneumex posturalwheelchair assessment
exerciseAROMdynamic lumbar stabnerve glidingneuro-reeducationPROMstrengtheningpneumex back program
modalitiesalpha-stimanodyne
electrical stimulationbiomodulator
fluidotherapyice-heationtophoresismicrolight laserondamedparaffinphonophoresisT.E.N.S.ultrasoundwhirlpooltraction
manual therapyactive release techniqueASTYMmanual lymphatic drainagemassagemuscle energy techniquemyofacial releasenerve-mobilizationpain neutralization techniqueprimal reflex release techniquespray & stretchstrain-counterstraintotal motion releasevisceral manipulation
splinting/bracinggel shellSI beltprefabricatedcustomdynamicanklehand/wristelbowknee
treatment goals increase ROM increase strength improve balance
improve function decrease pain decrease edema
home program return to work return to sports
programs post-op rehab home program rotator cuff repair pain management
spine
ACL reconstruction total joint replacement tendinitis / tendinosis work conditioning TMJ dysfunction
LSVT BIG program Biodex balance program
physician signature _________________________________________________
Thank you for choosing Advantage Therapy as your rehab provider.
2017 W. Woodland St.
Springfield, MO 65807
Phone: 417-889-4800
Fax: 417-889-0980
1845 E. Turner St., Ste E
SOUTH SPRINGFIELD NORTH SPRINGFIELD
Springfield, MO 65803
Phone: 417-864-5800
Fax: 417-864-5803
Se Habla Español
MONETT
864 E. US Hwy 60, Ste A
Monett, MO 65708
Phone: 417-635-1185
Fax: 417-635-1187
5528 N. Farmers Branch Rd., Ste B
OZARK
Ozark, MO 65721
Phone: 417-889-4800
Fax: 417-889-0980
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SPRINGFIELD
Advantage Therapy
Advantage TherapyMonett - Suite A864 E. US Hwy 60Monett, MO 65708Located nearBayou Restaurant
2017 W. Woodland St.Springfield, MO 65807
Advantage Therapy - NorthLocated near Kmart1845 E. Turner St, Ste ESpringfield, MO 65803
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Advantage TherapyOzark - Suite B5528 N FarmersBranch RoadOzark, MO 65721*Take theLambert’s Exit
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