Patient’s Name:

    CARDENAS PHYSICAL THERAPY

    MEDICARE PATIENTS

    IMPORTANT NOTICE
    2016

    Medicare will not pay for outpatient physical therapy if you are enrolled in home health care.

    If you are receiving any care in your home,provided by Medicare, it is important that you notify our office immediately.

    Are you now enrolled in Medicare Home Health?

    Yes, specify dates No If this changes it is your responsibility to notify Cardenas Physical Therapy immediately.


    Patient Signature

    Date


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