ACESOAI

APTA Registry patient episode of care panel

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