D KT 1000 - Tidewater Physical Therapy

D KT 1000 - Tidewater Physical Therapy

• Denbigh (757) 874-0032
Name
Date
Diagnosis
Frequency/Duration
Treatment/Orders
M Evaluate & Treat
MIsokinetic Evaluation
(Biodex, BTE)
M KT 1000 (Ligament Arthrometer)
Modalities
M Modalities as indicated
M Cold/Heat
M Anodyne
M Whirlpool
MElectric Stimulation/
Medcosonalator
M TENS
M Ultrasound/Phonophoresis
MIontophoresis
(Dexamethasone)
M Cervical/Lumbar Traction
M Spinal Decompression
M Vasopneumatic
Manual Techniques
M Mobilization
M Massage
M Myofascial Release
M Michigan State
• Gloucester Court House (804) 694-8111
• Gloucester Point (804) 642-3028
• Hampton – Executive (757) 838-6678
• Hampton – Magruder (757) 825-3400
• Hidenwood (757) 599-5551
• Norge (757) 345-0753
• Oyster Point (757) 873-2123
• Smithfield (757) 357-7762
• Williamsburg (757) 220-8383
• Williamsburg Hand Center (757) 565-3400
• Advanced Specialty Center (757) 220-8383
Exercises
M Exercise as indicated
M Exercise Consult
M Range of Motion/Stretching
M Strengthening Exercises
M McKenzie Exercises
Williams Exercises
M Gait Analysis/Training
M Aquatic Exercise
M Core Strengthening
Supplies/ DME
M Foot Orthotics
M Dorsiflexion Night Splint
M Bracing/Splint:__________________
________________________________
Occupational Performance Services
M Functional Capacity Evaluation
MPermanent Impairment Rating (AMA)
M Disability Rating (FCE & Impairment Rating)
M Work Conditioning
M Job Analysis/ Transitional Duty Design
Treatment Programs
M Fall Prevention Program
M Frozen Shoulder
M Golf Fitness Program
MIncontinence
Pelvic Pain Program
M Lymphedema Program
MOsteoporosis
Arthritis Program
M Plantar Fasciitis
M Shoulder Impingement
M Shoulder Instability
M Tennis Elbow
M TMJ Rehab
M Wound Care
M Back Rehab/ Stabilization
M Vestibular Rehabilitation
Physician’s Signature
I hereby certify these services as medically necessary
for the patient’s plan of care.
BKRP100 (11/10)
ng
hi
as
W
em
to
n
Cl
ay
Duv
a
e
rg
l St.
eo
G
Court
House
hn
t
M
Wa
lker
Ave
.
Main Stree
Jo
17
Fox Mill
Run Road
to
n
M
y.
w
.H
★
Fox Hunt Lane
em
17
T.C. Walker Road
Gloucester
Williamsburg Physical Therapy
Advanced Specialty Center
4125 Ironbound Road • Suite 100
(757) 220-8383 • Fax: (757) 253-7833
Williamsburg hand therapy center
156-B Strawberry Plains Road
(757) 565-3400 • Fax: (757) 565-6445
williamsburg
a
ro
ro
ad
Hampton-Magruder
9 Manhattan Square • Suite B
(757) 825-3400 • Fax: (757) 825-0392
colonial
williamsburg
John Tyle
Profes
616
r la
ne
l Dr.
siona
williamsburg
crossing
Shopping
center
der B
lvd.
5
ric
hm
on
d
laaininssrr
Strawberry Pl
ooaadd
199
John Tyler
hwy.
ass
byP
Mo
ntic
ell
oa
ve
.
To
richmond
60
199
60
r o u te
i ro
nd
ou
nb
ad
ro
wn
walsingham
sto
me
academy
Ja
The Hamptons
Golf Course
6
Ham
pton
261
Mi
le s
9 Manhattan
Square
Butler Farm
Rd.
Tysinger
Dodge
Exit
242
B
31
LAKE
Magru
6
Coliseum
Central
Exit
234
199
es
Mil
1/2
d
Newport News-Hidenwood
12655 Warwick Blvd. • Suite B
(757) 599-5551 • Fax: (757) 595-5238
Hampton-Executive
2106 Executive Drive
(757) 838-6678 • Fax: (757) 838-8116
Manhattan
Square
Denbigh
Gloucester Point
7190 Chapman Drive • Hayes, VA 23072
(804) 642-3028 • Fax: (804) 642-3467
.H
wy
Gloucester Court House
6965 Fox Hunt Lane • Suite 201
(804) 694-8111 • Fax: (804) 694-5574
➡
Newport News-Denbigh
12695 McManus Blvd. • Bldg. 6 • Suite B
(757) 874-0032 • Fax: (757) 874-0127
199
Road
s Cen
ter P
arkw
ay
To Newport News
Magruder
Toano
60 Ri
chm
o
nd
Rd
.
Norge
Newport News-Oyster Point
771 Pilot House Drive
(757) 873-2123 • Fax: (757) 873-3848
Smithfield
204 Gumwood Drive
(757) 357-7762 • Fax: (757) 357-7765
d.
rR
ke
oa
Cr
Norge
60
Williamsburg-Norge
7151 Richmond Road • Suite 101
(757) 345-0753 • Fax: (757) 345-2892