Get Geisinger Forms No No Download Needed Needed

Filling out the Geisinger Forms No No Download Needed Needed online is a straightforward process that helps streamline the initiation of outpatient rehabilitative therapy services. This guide provides step-by-step instructions to ensure users can complete the form accurately and efficiently.

Follow the steps to fill out the Geisinger form correctly.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin with Section 1, where you will need to provide the referral source details including the rehab provider facility name. Ensure that you fill out the member information, including last name, first name, and middle initial as required. This information is essential for processing the referral.
3. Complete the referring physician section by entering their first and last name, and also include the location and health plan provider number.
4. Enter the member's date of birth, address, and contact numbers including both phone and fax numbers. Be sure that this section is thoroughly completed to avoid any delays.
5. Specify the service requested by choosing from physical therapy (PT), occupational therapy (OT), or speech therapy (ST).
6. Indicate the site of service by choosing from options such as outpatient clinic, skilled nursing facility, hospital, Comprehensive Outpatient Rehabilitation Facility (CORF), or assisted living facility.
7. If applicable, provide details for other insurance information such as worker’s compensation or auto insurance by entering the company name, policy number, claim number, contact person, date of accident, and their phone number.
8. Fill in the diagnosis information section, including the ICD-9 code and a description of the diagnosis or condition being treated.
9. List any surgical procedures related to the current problem along with the dates they occurred, and also include any co-morbidities and psychosocial factors.
10. Proceed to Section 2 by assessing and describing the functional level of the member prior to the current problem. Detail the current problems and their duration, or note if the evaluation is attached or if only one visit is requested.
11. Outline the goals for therapy, providing multiple objectives for the treatment plan. Clearly define each goal to ensure measurable outcomes.
12. Conclude by drafting a plan of care that outlines the proposed course of treatment.
13. Sign and date the therapy section, then provide the necessary authorization number and the number of approved visits. Confirm discipline authorized (PT, OT, ST) in accordance with the treatment plan.
14. Finally, make sure to save changes, and choose to download, print, or share the form as necessary for submission.

Complete your Geisinger Forms No No Download Needed Needed online today for swift processing of rehabilitative services.