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Pennsylvania Hospital WELCOME TO Penn Therapy & Fitness Pennsylvania Hospital 330 SOUTH 9TH STREET 1ST FLOOR PHILADELPHIA, PA 19107 215.829.7275 FAX: 215.829.3384 MONDAY & FRIDAY: 7:30 A.M. – 5:00 P.M. TUESDAY – THURSDAY: 7:30 A.M. – 6:00 P.M. pennpartners.org/pennsylvaniahospital PTFWP-1 AEL 8/2018 528980N PTFWP-1 PA Hosp Welcome Cover Sheets.indd 1 8/14/18 7:42 AM ParkingParking & TransportationTransportation PENN THERAPYTHERAPY & FITNESSFITNESS PennsylvaniaPennsylvania HospitalHospital 330 SOUTH 9TH STREET ® 1ST FLOOR ® PHILADELPHIA, PA 19107 ® 215.829.7275215.829.7275 ForFor your convenience, PennPenn Therapy & FitnessFitness offers several parking options. VALETVALET PARKINGPARKING PUBLIC TRANSPORTATIONTRANSPORTATION ValetValet ParkingParking is available for patients and visitors of the PennPenn Therapy & FitnessFitness PennsylvaniaPennsylvania Hospital is PennPenn Neurological Institute building during our regular easily accessible by public transportation. The Market business hours.hours. East Station (at 11th and MarketMarket Streets) servesserves the Access valet parking on 9th Street, near the corner suburban regional rail lines and is a few blocks northnorth of Pine StreetStreet of PennPenn Therapy & Fitness.Fitness. In addition, many of thethe following public transportation routes are also within Fee payable to the parking attendant: Fee payable to the parking attendant: walking distance: Cash only; $11.00 for 2 hours; $13.00 for 3 hourshours SEPTASEPTA (in Pennsylvania) LOTLOT PARKINGPARKING Bus and trolley routes:routes: 9, 12, 17, 21, 23, 27, 32, Our parking lot is located at 8th and Delancey Street 33, 38, 42, 44, 47, 48, 61, 76, 90, C. (on the left between Spruce and Pine) Subway-surface routes:routes: 10, 11, 13, 34, 36 Fee:Fee: Credit cards accepted; $11.00 for 2 hours; $13.00 for 3 hourshours Subway lines: Broad Street Subway,Subway, Market-FrankfordMarket-Frankford Elevated Line Step 1 – Enter lot, press the button on the kiosk machine, take a ticket and proceed to parking. PATCOPATCO High Speed Line (from New Jersey)Jersey) Step 2 – Bring the parking ticketticket with you to the PennPenn Therapy and FitnessFitness Rittenhouse is within walking PennPenn Neurological Institute building. Present it to distance of the 9th/10th and Locust Street station. This is the valet attendant in the lobby to receive validation.validation. the second PATCOPATCO stop in Center City when traveling from New Jersey.Jersey. ForFor more information, call 856.772.6900 in Step 3 – Return to the parking lot and pay in the New Jersey or 215.922.4600 in Pennsylvania.Pennsylvania. officeoffice onon thethe firstfirst floo floor.r. Present Present your your tick ticketet at atthis this time time and you will receive the discounted parking rate. New Jersey TransitTransit ForFor information in New Jersey,Jersey, call 800.582.5946.800.582.5946. STREET PARKINGPARKING ForFor information in Pennsylvania,Pennsylvania, call 215.569.3752. Self-parking is available on the streets around PennPenn Therapy & Fitness.Fitness. Please note that the majority of Amtrak the streets now utilize Philadelphia ParkingParking AuthorityAuthority Amtrak trains stop at 30th Street Station (30th and payment kiosks. The green kiosk boxesboxes are located on MarketMarket Streets). ForFor information, call 800.872.7245. the curb side of sidewalks. 528980N PTFWP-1 PA Hosp Welcome Cover Sheets.indd 2 8/14/18 7:42 AM WELCOME TO Penn Therapy & Fitness This packet contains the documents necessary for your first visit. Please bring these forms with you. u Patient summary form (pages 3 & 4) u F orm should be signed upon your arrival. These forms must be signed with date and time in person and witnessed by our staff. Other important documents to bring with you to your first visit include: q You r pr escripti on( s), w hich must be sign ed a nd date d wit hin 90 day s of yo ur i nitial therap y ap pointme nt q Phot o I D a nd i nsu ra nce car d q Ins urance Re ferr al (if req uire d b y y our insur ance pla n) q Ins urance c op aym ent (if re quired by y our i nsur anc e pla n ) Co pay s are d ue eac h treatment day q Complete list of medicati on s q Complete medical hist ory list (if no t cov ered on patie nt sum ma ry for m) Your first scheduled app ointment is a one-on-one evaluation with your therapist. Your ev aluation may take up to 60 minutes. We ask you arrive 30 minutes before your appointment to complete the check-in process and start on time. If you have any questions, feel free to contact us . Please provide 24- ho ur notice if you need to cancel. Thank you, The Staff at Penn Therapy & Fitness Frequently Asked Que stions AT PE NN T HERAPY & FITNES S, our goal is to provide you with ex cellent care. PLEA SE SEE BELO W to understand how you can prepare for and participate in your care. 1) How long is the initial appointment? Your initial appointment will take up to 90 minutes from registration to completion of the evaluation. 2) When should I arrive? Arrive 30 minutes before your scheduled evaluation time to complete the registration process. A Patient Service Representative may contact you to modify this arrival time based on your diagnosis and prior completion of Intake documentation. 3) What is involved in the registration process? The registration process may take up to 30 minutes. Patients will be asked to complete a medical history questionnaire, including their explanation of the issue for which they are being evaluated, their goals and report of pain, if any. Patients will also complete a baseline functional outcome measure. All patients will sign informed Consent and review Patient Privacy and Bill of Rights forms. 4) What will occur during the initial evaluation? Your therapist will ask you questions regarding your condition, perform a physical exam and develop an individualized program to help facilitate your goals. 5) What should I do if I am running late for an appointment? It is important that you arrive on-time for all appointments. Your individualized plan of care will be developed in collaboration with you based on an expected frequency and the duration of each appointment. If you are running late, call the office to make us aware. We will do our best to accommodate you. However, it is possible that you may need to see another therapist on your care team or reschedule. 6) What happens if I need to cancel and reschedule? It is important that you consistently attend all scheduled appointments. The purpose of your rehabilitation program is to restore your maximal functional status as quickly and as safely as possible. In order to achieve the best therapeutic outcome, it is important that you meet your agreed-upon plan of care and consistently attend all scheduled appointments. If you must cancel or reschedule, we require that you call at least 24 hours in advance of the scheduled appointment date and time. In addition, if you fail to attend three scheduled appointments without proper notification, your care may be discharged and your referring provider may be notified. 7) What should I wear? Wear comfortable clothing, including sneakers or rubber-soled shoes without a heel. If you are coming for issues related to your low back or legs, please bring or wear shorts. 8) Will I have follow-up appointments? After the examination, you and your therapist will develop a plan of care, including your goals for therapy. Together, you and your therapist will determine the appropriate follow-up, including the duration and frequency of visits for your course of care. 9) Do I really need to do my home exercise program? Yes. A home exercise program is an essential part of your recovery. You will be given pictures, as well as written instructions on how to perform your particular program. 10) What should I do if I experience pain or discomfort? Stop. If an exercise caused unexpected discomfort or pain, or if you are unsure about an exercise, stop. Contact our office with immediate questions or concerns. Your therapist will review your exercises with you either during your call or at your next visit. IF YOU H AVE ANY QUE STIONS OR CONCERN S prior to your first appointment, please call our office and we will be happy to answer them. LABEL AREA Patient Summary Form Name: Date of Birth: / / Age: Home Phone #: Cell Phone #: E-mail: Preferred means of contact:: Phone Email EMERGENCY CONTACT: Name: Phone #: MEDICAL HISTORY: Are you currently receiving any Home Care Services? Yes No Are you currently receiving any other Therapies? Physical Occupational Speech None Current quality of life/health status: Excellent Very Good Good Fair Poor Please check Yes or No as appropriate for the following conditions. Asthma/Wheezing/Shortness of Breath Yes No Cataracts Yes No Circulatory Problems Yes No Frequent Cough Yes No Glaucoma Yes No Blood Clot Yes No Pneumonia Yes No Low Blood Pressure Yes No Leg Wounds Yes No Sinus Infections Yes No High Blood Pressure Yes No Diabetes Yes No Weight Changes: gain / loss Yes No Congestive Heart Failure (CHF) Yes No Kidney Disease / Renal Failure Yes No Frequent Laryngitis Yes No Heart Disease Yes No Thyroid Disorder Yes No Frequent Sore Throat Yes No Pacemaker Yes No Incontinence Yes No Difficulty Swallowing Yes No Arthritis Yes No Bowel Irregularity Yes No GERD/Reflux Yes No Osteoporosis / Osteopenia Yes No Urinary Frequency / Urgency Yes No Poor Appetite Yes No Chronic Back Pain Yes No Bladder Infections Yes No Frequent Nausea / Vomiting Yes No Peripheral Neuropathy Yes No Tuberculosis Yes No Hearing Loss Yes No Aneurysm Yes No Immune Deficiency Yes No Vertigo / Dizziness Yes No Seizure Yes No Anxiety Yes No TMJ Yes No Stroke / TIA Yes No Depression Yes No Panic Attacks Yes No Diagnosis of Cancer Yes No If yes, state type of cancer Date diagnosed: Radiation Yes No Chemotherapy Yes No SURGICAL HISTORY: List any surgical history.
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