Fletcher Allen, a Vermont university hospital and medical center, serves all of
Vermont and the northern New York region. Located in Burlington, Fletcher Allen is a regional, academic healthcare center and teaching hospital in alliance with the University of Vermont.
Physical Therapy Referral Information
Physical therapists, or PTs, are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PTs assess joint motion, muscle strength and endurance, function of the heart and lungs, and performance of activities required in daily living, among other responsibilities. Treatment includes therapeutic exercise, cardiovascular endurance training, and training in activities of daily living.
Locations:
Rehabilitation Therapy
Orthopedic Specialty Center
192 Tilley Drive
South Burlington, VT 05403
Phone: 802-847-7910
Fax: 802-847-6987
South Burlington Family Practice
3 Timber Lane
South Burlington, VT 05403
Phone: 802-847-6185
Fax: 802-847-6140
Rehabilitation Outpatient Center
Fanny Allen Campus
790 College Parkway
Colchester, VT 05446
Phone: 802-847-1902
Fax: 802-847-6943
Referral Information
This is information the Physical Therapist needs to provide the best care for your patient.
Questions and Issues For You to Consider When Referring Your Patients
1. Please describe the duration of the problem. What is the urgency of the referral?
2. Make sure the goals / expectations for treatment are reasonable and achievable.
3. Is the patient presently seeing an OT, PT, speech/language pathologist, or psychologist? If yes, who is treating the patient?
4. If no, has the patient been seen recently by an OT/ PT for the problem?
5. Does the patient have any precautions / limitations for exercise?
6. Medicare patients have to be seen within 30 days of referral.
7. Please call the Therapist if the patient’s problem is out of the ordinary or if special treatment is required.
8. If managed care, is the referral in place?
Medical/Surgical Information
Most Important
1. Name of Referring MD/Provider / Phone / Fax
2. Reason for Referral and Expectations
3. Problem List
4. Medication / Allergy List
5. Most Recent Office Note Pertaining to the Visit
6. ICD-9 Code for the Diagnosis
7. Name and Phone Number of the Patient’s Current OT /PT
8. Previous Course of Treatment
9. Precautions, if Any
Please send the following information if pertinent to the referral.
1. Outside Consult Reports
2. Operative Reports
3. Imaging Reports
4. Procedure Reports
5. Specialized Test or Most Recent Office Note Summarizing the Above
Please send the following information, if relevant.
1. Problem List
2. Hospital Discharge Summary if Pertinent to the Referral
Patient Demographic Information
Name, Date of Birth, Address, Phone Number, Insurance Plan, Worker’s Compensation Information, if applicable
