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Advocate Condell Medical Center Rehabilitation Services

Advocate Condell Medical Center Rehabilitation ServicesPhysical Therapy Occupational Therapy Speech TherapyCALL Name: _____ ICD9 Code: _____Diagnosis: _____ Surgery/Procedure: _____ _____ Date of Surgery: _____ General: q Evaluate and Treat q PT q OT q ST Weight Bearing Status: _____Treatments Per Week: q x1 q x2 q x3 Duration (weeks): q 1 q 2 q 3 q 4 q 5 Adult Rehab Specialtiesq Return to Work Program q FCE q Work Conditioning q Ergonomicsq Sports Medicine q Lymphedemaq Speech q Swallow/Feeding q CognitionPediatric Rehab Specialtiesq Balance/Vestibularq Aquatic Therapyq Sports Medicineq Speech q Swallow/Feeding q Cognitionq Neurodevelopmental Treatmentq Sensory Integration (SI)Additional instructions/precautions/contraindicatio ns: _____Follow Protocol For: _____MD Signature: _____ Date: _____Libertyville Condell Medical Center West Tower 801 S.

Advocate Condell Medical Center Rehabilitation Services ... Gurnee Lincolnshire Centre Club 1405 Hunt Club Rd. Gurnee, IL 60031 P 847.855.2890 ... Advocate Condell Medical Center Rehabilitation Services Physical Therapy • Occupational Therapy • …

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