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Doctor of Physical Therapy Documentation of Volunteer Hours This form is to be completed by the applicant and verified by the Physical Therapist supervising the experience. Office use only. Do not write in this box. Applicant s Name HSC Badge Facility Name/Address Facility Phone Date Arrived Time IN Time OUT Initials of PT Supervisor Hours Attended Total Hours Attended This is to certify that attended from to Name of facility Date for a total of specify of Hours. Physical Therapist Signature DO NOT RETURN THIS FORM TO UTHSCSA. HOLD ONTO IT UNTIL YOU RECEIVE FURTHER INSTRUCTION* Guidelines for 50 Volunteer Hours of Physical Therapy Experience To be a stronger D. P. T. student candidate the following are recommended experiences for the required 50 volunteer hours 1. Observe actual examinations of physical therapy patients. Examples strength locomotion function and others tests and measures. 2. Observe treatment interventions of patients by physical therapists. Examples therapeutic exercise manual therapy functional training gait training and modalities such as ultrasound and electrical stimulation* 3. Become familiar with the equipment used in the physical therapy department. 4. View a blank patient billing sheet and physical therapy notes/documentation in various physical therapy settings. 5. Experience multiple physical therapy settings. Examples a* Orthopedic e*g* Diagnoses of low back strain cervical/neck strain rotator cuff tear total knee replacement b. Neurologic e*g* Diagnoses of cerebral vascular accident CVA stroke traumatic brain injury spinal cord injury c* Cardiopulmonary e*g* Diagnoses of chronic obstructive pulmonary disease myocardial infarction d. Pediatric e*g* 21 years with diagnoses of cerebral palsy spina bifida muscular dystrophy e. Geriatric e*g* 65 years with diagnoses of osteoporosis total hip replacement cancer Parkinson s disease Alzheimer s 6. Please find opportunities to observe in a variety of settings. Examples a* Acute Care b. Inpatient Rehabilitation c* Skilled Nursing Facilities d. Outpatient e. School Systems f* Home Health Copyright 2015 UTHSCSA Office of Admissions Special Programs School of Health Professions 4-15/cm. Office use only. Do not write in this box. Applicant s Name HSC Badge Facility Name/Address Facility Phone Date Arrived Time IN Time OUT Initials of PT Supervisor Hours Attended Total Hours Attended This is to certify that attended from to Name of facility Date for a total of specify of Hours. Physical Therapist Signature DO NOT RETURN THIS FORM TO UTHSCSA. HOLD ONTO IT UNTIL YOU RECEIVE FURTHER INSTRUCTION* Guidelines for 50 Volunteer Hours of Physical Therapy Experience To be a stronger D. Physical Therapist Signature DO NOT RETURN THIS FORM TO UTHSCSA. HOLD ONTO IT UNTIL YOU RECEIVE FURTHER INSTRUCTION* Guidelines for 50 Volunteer Hours of Physical Therapy Experience To be a stronger D. P. T. student candidate the following are recommended experiences for the required 50 volunteer hours 1. P. T. student candidate the following are recommended experiences for the required 50 volunteer hours 1. Observe actual examinations of physical therapy patients. Examples strength locomotion function and others tests and measures.

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