APTA Reg org data pnl
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APTA Reg prov data panel
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APTA Reg pt reg pnl
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APTA Reg pt EOC pnl
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Federal employer tax ID Organization
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Pt ID
?
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Pt ID
?
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Federal employer tax ID Organization
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Organization Name
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Organization Name
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Pt ID assign auth
?
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Pt ID assign auth
?
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Patient Last name
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Name Facility
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Organization EOC unique ID
?
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Organization ZIP code
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Provider First name
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National provider ID:ID:Pt:Provider:Nom:
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Name Facility
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Patient First name
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Patient middle name
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Provider Last name
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Provider Last name
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Postal code Facility
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National provider ID:ID:Pt:Provider:Nom:
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National provider ID:ID:Pt:Provider:Nom:
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Provider First name
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Birth date
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{mm/dd/yyyy}
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Social Security #
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Primary insurance
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Middle name Provider
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Sex of Provider
?
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Medicare or comparable #
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Postal code
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Birth Date Provider
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{mm/dd/yyyy}
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Secondary insurance
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Sex:Type:Pt:^Patient:Nom:HL7.v3
?
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Race OMB.1997
?
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PT referral source APTA
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Provider race OMB.1997
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Care transfer loc APTA
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Provider ethnicity OMB.1997
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Ethnicity OMB.1997
?
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Provider Grad year
?
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{yyyy}
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Marital status+living arrang
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EOC dx.primary
?
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Date of onset Reported
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{mm/dd/yyyy}
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Patient Email address
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Grad state Provider
?
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PT provider type APTA
?
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EOC dx.secondary
?
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Surg hx relevant to PT tx
?
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PT Prov entry-level degree
?
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PT Prov highest educ
?
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Date+time of surgery
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{tmstp}
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Prem infant
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PT provider residency or fellowship APTA
?
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PT provider specialty APTA
?
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GA--@ birth
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wk
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Weight Measured
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Body height Measured
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Tobac smoke stat
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Physical Activity APTA
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PT init visit Pnl
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PT sub visit Pnl
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PT reexam pnl
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PT concl of care Pnl
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PT POC Pnl
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APTA Reg ids pnl
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Pt ID
?
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Pt ID
?
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Pt ID
?
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Pt ID
?
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PT loc registry ID
?
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Pt ID
?
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Pt ID assign auth
?
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Pt ID assign auth
?
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Pt ID assign auth
?
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Pt ID assign auth
?
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PT org registry ID
?
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Pt ID assign auth
?
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Organization EOC unique ID
?
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Organization EOC unique ID
?
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Organization EOC unique ID
?
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Organization EOC unique ID
?
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Phys therapist reg ID
?
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Organization EOC unique ID
?
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Federal employer tax ID Organization
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Federal employer tax ID Organization
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Federal employer tax ID Organization
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Federal employer tax ID Organization
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Episode of care unique ID
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Federal employer tax ID Organization
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Name Facility
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Name Facility
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Name Facility
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Name Facility
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Name Facility
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Date of first visit
?
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{mm/dd/yyyy}
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Visit date
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{mm/dd/yyyy}
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Visit date
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{mm/dd/yyyy}
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PT Discharge date
?
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{mm/dd/yyyy}
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Patient Last name
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Provider First name
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Provider First name
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Provider First name
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Provider First name
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Patient First name
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Provider Last name
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Provider Last name
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Provider Last name
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Provider Last name
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Patient middle name
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National provider ID:ID:Pt:Provider:Nom:
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National provider ID:ID:Pt:Provider:Nom:
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National provider ID:ID:Pt:Provider:Nom:
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National provider ID:ID:Pt:Provider:Nom:
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Birth date
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{mm/dd/yyyy}
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Provider role
?
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Provider role
?
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Provider role
?
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Provider role
?
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Sex:Type:Pt:^Patient:Nom:HL7.v3
?
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Diagnosis.primary:Imp:Pt:^Patient:Nom:
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Intervention or services provided pnl
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Diagnosis.primary:Imp:Pt:^Patient:Nom:
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Movement system dx
?
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Patient Email address
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Dx.secondary
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Billing info pnl
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Dx.secondary
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Diagnosis.primary:Imp:Pt:^Patient:Nom:
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Date of first visit
?
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{mm/dd/yyyy}
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Movement system dx
?
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Movement system dx
?
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Dx.secondary
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Provider First name
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Primary health cond
?
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Primary health cond
?
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Primary health cond
?
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Provider Last name
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Other health condition
?
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Other health condition
?
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Other health condition
?
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National provider ID:ID:Pt:Provider:Nom:
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Body function ICF code
?
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Body function ICF code
?
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Body function ICF code
?
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Care team info Pnl
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Body structure ICF code
?
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Body structure ICF code
?
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Body structure ICF code
?
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PT health concerns Pnl
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Activities and participation ICF code
?
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Activities and participation ICF code
?
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Activities and participation ICF code
?
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PT goals Pnl
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Clinical presentation status
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Clinical presentation status
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Reason for discharge APTA
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Planned intervention or services Pnl
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Medication documentation status
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Medication documentation status
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Care transfer loc APTA
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Prescriptions
?
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Prescriptions
?
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Pt satisfaction w healthcare Score
?
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{score}
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Prognosis for rehabilitation
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Prognosis for rehabilitation
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Prescriptions
?
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Glob meas of phys function Pnl APTA
?
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Glob meas of phys function Pnl APTA
?
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Glob meas of phys function Pnl APTA
?
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Condition-spec function Pnl APTA
?
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Condition-spec function Pnl APTA
?
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Condition-spec function Pnl APTA
?
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Self-care and mobility Pnl APTA
?
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Self-care and mobility Pnl APTA
?
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Self-care and mobility Pnl APTA
?
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PT goals Pnl
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PT goals Pnl
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Intervention or services provided pnl
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Planned intervention or services Pnl
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Planned intervention or services Pnl
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Billing info pnl
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Intervention or services provided pnl
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Intervention or services provided pnl
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Billing info pnl
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Billing info pnl
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Instructions provided
|
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Provider Last name
|
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Diagnosis.primary:Imp:Pt:^Patient:Nom:
|
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Planned interv +or serv dur time frame
|
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wk
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PT goal
|
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Dx.secondary
|
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Provider First name
|
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Airway clearance technique perf
|
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Planned interv +or serv dur visits
|
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{#}
|
PT goal attain dur - time frame
|
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wk
|
Planned interv +or serv visit freq
|
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Movement system dx
?
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PT goal attain dur - visits
?
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{#}
|
National provider ID:ID:Pt:Provider:Nom:
|
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Assistive technology prov
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Instructions plan
|
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Provider role
?
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Biophysical agent used
|
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Primary health cond
?
|
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Other health condition
?
|
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Functional training perf
|
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Airway clearance technique plan
|
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Body function ICF code
?
|
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Integ repair protect technique
|
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Assistive technology plan
|
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Body structure ICF code
?
|
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Manual therapy technique used
|
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Biophysical agent plan
|
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Functional training plan
|
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Motor function training perf
|
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Activities and participation ICF code
?
|
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Integ repair protect technique plan
|
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Prognosis for rehabilitation
|
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Ther exercise perf
|
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Other intervention or service provided
|
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Manual therapy technique plan
|
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Reason for referral:Find:Pt:^Patient:Nar:
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Motor function training plan
|
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Ther exercise plan
|
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Other intervention or service plan
|
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