Wayne’s World of Rehab
Physical Therapy Progress Note
PATIENT NAME
DOB
DIAGNOSIS
CERTIFICATION PERIOD
REFERRING PHYSICIAN
CO-MORBIDITIES
MEDICATIONS
Date:
Visit#:
SUBJECTIVE
OBJECTIVE
Range of motion:
Strength:
Function:
Other:
Treatment today:
Manual Therapy:

Therapeutic Exercise:

ASSESSMENT
PLAN
CODE
97110 (Therapeutic Exercise)
97112 (Neuro Re-ed)
97140 (Manual Therapy)
97530 (Ther Activity)
97035 (ultrasound)
97014 (estim, unattended)
Total
____________________
Time spent
Units
[Therapist name]