Physical Therapy Orders

    Evaluate and Treat

    TractionJoint MobilizationSoft Tissue MobilizationStretching
    Passive ROMActive Assisted / Active ROMStrengtheningCore StabilizationProprioceptive Training
    Moist Heat / IceUltrasoundElectrical StimulationIontophoresis

    I certify that this patient is under my care and requires physical therapy treatment as prescribed above.

    Printable form with fax instructions