Get Pulmonary Rehab Order Form

Completing the Pulmonary Rehab Order Form online is an essential step in referring individuals to the necessary rehabilitation services. This guide will help users navigate the form with clear instructions and support.

Follow the steps to successfully complete the Pulmonary Rehab Order Form online

1. Press the ‘Get Form’ button to access the Pulmonary Rehab Order Form online. This action will allow you to open the form in an editable format.
2. Begin by entering the patient's name in the designated space at the top of the form.
3. Fill in the patient's address, including street name and number, city, state, and zip code.
4. Input the patient’s phone number in the appropriate field, ensuring the format is correct.
5. Record the patient's age, sex, and date of birth in the specified sections.
6. Check the appropriate diagnosis from the provided list. Be sure to select all applicable conditions that describe the patient’s health status.
7. Select the appropriate program for the patient by marking either Phase II or Phase III in the relevant section.
8. Indicate the plan regarding a Pulmonary Function Test for the patient by checking one of the provided options.
9. Complete the section on other pertinent medical history, noting any physical limitations or related information.
10. List any allergies the patient has, along with relevant medications and dosages in the appropriate spaces.
11. Ensure that the referring physician’s signature is provided at the bottom of the form, along with the date of signing.
12. Once all fields are completed, review the form for accuracy, and save your changes. You can then download, print, or share the completed form as needed.

Take action today and fill out the Pulmonary Rehab Order Form online to ensure timely care for your patient.