Rehabilitation Referral Forms for Physicians
A physician鈥檚 referral is required for most programs at 觅圈资源站 Langone鈥檚 Rusk Rehabilitation. The required forms are listed below:
- Adult General Occupational Therapy
- Assistive Technology: Occupational Therapy
- Barrier-Free Design: Occupational Therapy
- Brain Injury Day Treatment Program
- Breast Cancer
- Cardiac Rehabilitation
- Chest Physical Therapy
- Cochlear Implants
- General Physical Therapy
- Head and Neck Speech鈥揚athology
- Lymphedema
- Outpatient Adult Multidisciplinary Therapy
- Pelvic Floor Physical Therapy
- Prenatal/Postpartum Physical Therapy
- Psychology
- Pulmonary Rehabilitation
- Speech鈥揕anguage Pathology
- Vestibular Physical Therapy
- Vision Rehabilitation: Occupational Therapy
- Vocational Rehabilitation
Referral Information for Medical Facilities
To initiate a referral to Rusk Rehabilitation, the patient鈥檚 current social worker should review our discharge checklist and use Allscripts or fax to send the appropriate medical records to 212-263-8510. These should include the following:
- face sheet, including demographic and insurance information
- medical history and physical
- active medication list
- most recent lab results from the last 48 hours, including complete blood count and basic metabolic panel; last 3 sets of labs
- diagnostic and imaging reports
- medical consults, such as cardiology, neurology, gastroenterology, ophthalmology, or endocrinology
- notes from the last 72 hours as well as initial notes
- notes from physical therapy, occupational therapy, and speech鈥搇anguage pathology therapy
- most recent progress notes from the primary team
- operating room notes, if applicable
- social work assessment, including information about the patient鈥檚 social situation, to allow our team to create a post-rehabilitation plan
- nursing unit phone number
- resident and attending physician phone numbers
After Rusk Rehabilitation鈥檚 outreach and admissions team receives this information and the referral, a member of the clinical liaison team contacts the referring social worker, the patient, and if appropriate, the patient鈥檚 family. To contact the outreach and admissions team, please call 212-263-6034.