Physical Therapy Orders





Evaluate and Treat


 Traction Joint Mobilization Soft Tissue Mobilization Stretching


 Passive ROM Active Assisted / Active ROM Strengthening Core Stabilization Proprioceptive Training


 Moist Heat / Ice Ultrasound Electrical Stimulation Iontophoresis




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




Printable form with fax instructions