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13 Cards in this Set
- Front
- Back
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Initial this part of the Authorization for Release of Health Information Pursuant to HIPAA and sign form |
item 9B |
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List the 4 forms that are presented to the ICO |
Certification of LOD Injury/Authorization for Treatment (photocopy) Authorization for Release of Health Information Pursuant to HIPAA (photocopy) Therapy Verification Notification of LOD Therapy Authorization |
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Give these forms to your therapist before treatment |
Certification of LOD Injury/Authorization for Treatment (photocopy)
Authorization for Release of Health Information Pursuant to HIPAA (photocopy) |
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Get this information from your therapy provider and forward to Roll Call |
Schedule of treatments. Any change in the therapy schedule gets reported to Roll Call personnel |
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Update this form after each physical therapy session |
Therapy Verification form. Give the completed form to the ICO once the final physical therapy treatment has been done |
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Physical therapy authorized by a district surgeon is never granted for this type of injury |
Never granted for a non LOD injury. The fact that a member is on restricted duty does not entitle them to attend physical therapy on duty |
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When you have to go to physical therapy at the beginning of tour, you will report on duty upon arrival at therapy location and be given this much time to get back to the command once you're finished |
You'll be given a reasonable amount of time to travel back to command |
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When you have to go to physical therapy in the middle of your tour, you'll be given this much time to go, do your therapy and get back |
You'll be given a reasonable amount of time to get to the therapy location, complete the therapy, and a reasonable amount of time to get back to the command |
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When you have to go to physical therapy near the end of your tour, you'll be given this much time to get to the therapy location |
You'll be given a reasonable amount of time to get to the therapy location, but once you're done with therapy you will EOT from there and no time will be granted for you to go home. If you finish therapy before EOT, you must ask for lost time by calling the command |
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If your therapy is scheduled after the start of tour and you'd rather go straight there from home, you must hand this in |
Hand in a 28 for lost time if your physical therapy is set after the start of tour and you just want to go there from home |
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If your therapy is scheduled after the start of tour and you don't want to take lost time up front, you may request this |
You may request a tour change and begin tour upon arriving at the therapy location, needs of the service permitting |
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A change of tour should not be granted for the sole purpose of this |
A change of tour should not be granted for the sole purpose of ensuring therapy occurs during department time (ie: if you do midnights, you shouldn't get tour changed to a day tour so you can go to an afternoon therapy session) |
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How many physical therapy sessions may a District surgeon authorize? What if a MOS needs more sessions than that? |
District surgeon may authorize 12 PT sessions and can repeat the authorization 2 more times for a total of 36 sessions. If a MOS needs more than 36 sessions, they have to obtain authorization from a Dept Orthopedist |
