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Get and Sign TER to KP Direct Referrals the CHP Group  Form

Get and Sign TER to KP Direct Referrals the CHP Group Form

Use a TER To KP Direct Referrals The CHP Group 0 template to make your document workflow more streamlined.

Additional check one Chiropractic of Additional Treatments Requested check one 1 2 3 Dates to Initial Complaints and Pain Score s /Outcome Assessment Tool Initial objective findings Diagnosis must relate to original referral Treatment Provided including number modalities exercises patient education etc. Response to treatment Current complaints Pains Score s /Outcome Assessment Tool Current objective findings Expected outcome/prognosis Signature Date Please complete this form typed with standard...
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