Fillable Mc2113p Medical Therapy Unit (MTU) Summary

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Mc2113p Medical Therapy Unit (MTU) Summary

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State of California—Health and Human Services Agency Department of Health Care Services
California Children’s Services
MC 2113 P (09/07)
MEDICAL THERAPY UNIT (MTU) SUMMARY
Name (last) (AKA) (first) Date of birth State file number
Educational placement Diagnosis
Therapist(s) MTU/company
Evaluations:
❒ ADL ❒ ROM ❒ MMT ❒ Home evaluation ❒ A/V
❒ Motor maturity ❒ Reflex testing ❒ Sensory ❒ Perception ❒ Other: ___________________________________
Referral date Date of report Period covered Number of treatment units scheduled Given
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Mc2113p Medical Therapy Unit (MTU) Summary

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Completed 3 July 2020

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