PT/OT Referral Form

PT/OT Referral Form - (Forms/Publications)
Document Information
  Get help downloading & printing files.   How to complete a fillable form.
Title PT/OT Referral Form (108 KB DOC)

Attending Providers use this form to refer injured workers for physical or occupational therapy to progressively increase activity and exercise, or activity tolerance, develop home or self-care programs, and perform work activity conditioning. Explains to therapists your specific requests and expected follow-up therapy reports.

Form number F252-099-000
Order it
Keywords attending provider, referral, therapy
Languages English
Valid dates 10-2013
Contact information Managing Injured Workers' Claims
Claims for Job Injuries
Web pages For Medical Providers

End of main content, page footer follows.

Access Washington official state portal

© Washington State Dept. of Labor & Industries. Use of this site is subject to the laws of the state of Washington.