General Evaluation Form for Physical Therapy
The General Evaluation Form is designed for patients visiting the University of Utah Student-Run Pro Bono Clinic. It collects essential information regarding the patient's condition, history, and treatment plan. This form is a crucial step for effective physical therapy assessment and intervention.
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How do I fill this out?
To fill out this form, start by providing your personal information including your name and contact details. Next, describe your chief complaints and history of your present injury. Follow the instructions in each section for detailed insights into your symptoms and previous treatments.
How to fill out the General Evaluation Form for Physical Therapy?
1
Begin with entering your personal information accurately.
2
Detail your chief complaint and current symptoms.
3
Provide your medical history and any allergies.
4
Describe your goals for physical therapy treatment.
5
Review all entries before submission to ensure accuracy.
Who needs the General Evaluation Form for Physical Therapy?
1
Patients looking to undergo physical therapy require this form to assess their needed treatment.
2
Physical therapists use this form to collect vital patient history and current condition.
3
Administrative staff need this form for scheduling and insurance purposes.
4
Healthcare professionals might request this form to understand a patient's rehabilitation journey.
5
Students training in physical therapy need this form for educational and practical assessments.
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How do I edit the General Evaluation Form for Physical Therapy online?
Editing this PDF on PrintFriendly is simple and user-friendly. You can easily adjust text fields and update your responses directly in the document. This allows for efficient updates to patient information before finalizing the form.
1
Open the PDF on PrintFriendly to access the editing tools.
2
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5
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What are the instructions for submitting this form?
To submit the General Evaluation Form, please send it via email to info@utahprobono.org or fax it to (801) 123-4567. You may also drop off a physical copy at the University of Utah Physical Therapy Department at 1234 Healthcare Drive, Salt Lake City, UT. Make sure to submit your form 24 hours before your scheduled appointment to ensure timely processing and a smooth visit.
What are the important dates for this form in 2024 and 2025?
No specific important dates for this form are applicable in 2024 and 2025. However, keep in mind to fill out and submit the form prior to your therapy sessions for effective treatment planning.
What is the purpose of this form?
The General Evaluation Form serves to gather crucial data regarding the patient's health status, complaints, and treatment history. It supports therapists in developing tailored interventions and establishing a strong patient-provider relationship. Overall, this form aims to optimize patient care in physical therapy settings.
Tell me about this form and its components and fields line-by-line.
- 1. Pt Name: Patient’s full name for identification.
- 2. Diagnosis: The diagnosis provided by the referring physician.
- 3. Visit #: The unique number allocated for this visit.
- 4. Time in: The time the patient arrived for their appointment.
- 5. Time out: The time the patient left after the session.
- 6. Chief Complaint: What the patient primarily needs help with.
- 7. History of present injury: Details about the injury that led the patient to therapy.
- 8. Current Symptoms: Any ongoing symptoms related to the condition.
- 9. Medical History (PMH): Relevant medical history and past treatments.
- 10. Current Function %: Percentage of current function as perceived by the patient.
What happens if I fail to submit this form?
Failing to submit the General Evaluation Form may delay the initiation of your therapy sessions. This can result in unaddressed pain or disability continuing, impacting your overall health. It's crucial to ensure timely submission for a smooth therapy process.
- Delayed Treatment: Without submission, your therapy cannot start on schedule.
- Increased Symptoms: Ignoring to submit may worsen current health issues.
- Administrative Confusion: Incomplete forms can lead to issues with scheduling and insurance.
How do I know when to use this form?
- 1. Initial Assessment: For first-time evaluations to gather pertinent health information.
- 2. Therapy Progression: When reviewing changes in conditions to adjust therapy plans.
- 3. Referral Details: Following-up on referrals to understand patient history.
Frequently Asked Questions
Can I edit the General Evaluation Form?
Yes, you can easily edit the form's text fields on PrintFriendly.
How do I download the completed form?
Once you're done editing, simply click the download button to save your PDF.
Is it possible to send the PDF to my therapist?
Absolutely! Use the share feature to send the PDF directly via email.
What if I need to change my answers?
You can reopen the PDF on PrintFriendly and edit your answers anytime.
Can I print the edited form?
Yes, after editing, you can print the form directly from PrintFriendly.
What is the purpose of this evaluation form?
This form assesses the patient's condition for effective physical therapy.
Who should fill out this evaluation form?
Patients seeking physical therapy services should fill out this form.
Can I save my changes on PrintFriendly?
You can download your edited PDF, but there's no save function on the site.
Is there a guide for filling out the form?
Instructions are provided within the form for guiding users.
What information do I need to provide?
You'll need to share personal details, symptoms, and medical history.
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