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How to refer a patient

NOTE:  I would enjoy and appreciate the opportunity of speaking with you by phone and/or in person to explain what my services can offer your patients (or not). If I am on site, I am happy to do a 5 minute ‘tutorial’ with your staff on ‘how to refer’ patients to make things easy for all.

Also note, I would really love to treat you or a medical staff member so that you can experience this type of powerful treatment. I only need 10-15 minutes to make a difference.


If you are a medical provider and would like to refer a patient to Jera for physical therapy services of any kind,  please follow these 3 easy steps:

  1. Complete the referral slip (see below) including the ICD-9’s and any concerns for the patient.

  2. FAX it directly (858)408-2613 to me (it is confidential) or give it to the patient to bring in.

  3.  FAX all patient information IF it is available (via EMR). It is much appreciated!

What to expect from Jera/Alternative Physical Therapy:

  1. An initial evaluation or a summary report after 1-2 trial visits

  2. The Patient to be referred back to you IF no response within 2-4 visits.

  3. Only the utmost professional level of experience and care for your patient

  4. The possibility of additional communication that would assist in your patient’s progress/care.

  5. APT is a private-pay practice so patients will be asked to pay at time of service and then assisted in billing their own insurance with with a ‘superbill’ so that they may be reimbursed directly according to their OUT of Network benefit. (This will be explained when they call).

Patients using MEDICARE:

  1. You may refer the patient for abdominal pain, IBS, GERD, etc but to date these ICD-9’s are not allowed for PT to treat under these in SoCal. So, screen the patient for OTHER pain that may be included and used as the ‘treating’ diagnosis. This most commonly is associate back pain, thoracic pain, pain in limb, gait difficulty, etc. Feel free to contact Jera directly for more info.

  2. IF Medicare can be billed then I will inform the patient of the process/risks accordingly.

  3. YOU will receive a Medicare 700 form (INITIAL Plan of Care) that MUST be signed and faxed back in a timely manner to document the communication (mandatory for PT).  Subsequently a 701 (updated POC) will be done every 4-8 weeks with the same procedure.