If you have ever been self-employed or own a small business, you know that filing your taxes can be a little more complicated than when you are employed by someone else. One of the forms that is commonly used by self-employed individuals and small business owners is Form Nf 602. This form is used to calculate your net profit or loss from your business activities. Let's take a closer look at what this form is and how you can use it to file your taxes. Form Nf 602 is used to report the net profit or loss from a sole proprietorship or partnership. This form is similar to Schedule C, which is used by employed individuals to report their income and expenses. The main difference between Form Nf 602 and Schedule C is that Form Nf 602 includes information about the ownership structure of your business and any losses that were generated during the year. You will need to complete Form Nf 602 if you had net profits from your business activities, even if those profits were not taxable. You wi
| Question | Answer |
|---|---|
| Form Name | Form Nf 602 |
| Form Length | 1 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 15 sec |
| Other names | morbidities, tx, contraindicated, uhc acn form |
PT/OT NOTIFICATION FORM
ACN Group, Inc. - Form
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Patient s Name (Last, First, MI) |
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Patient’s Date of Birth |
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Instructions
Complete this form and submit via Web, mail, or fax to ACN Group within 3 days of the initial date of service. www.acnprovider.com
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Patient’s Insurance ID# |
Health Plan |
Group Number |
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Referral Info (If required by health plan as stated on your Plan Summary.)
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Yes |
No |
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Referred |
Referring Doctor |
Date Referral Issued |
Referral # |
Condition referred for |
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Type of Service |
Nature of Condition |
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Functional Outcome Measure Score |
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PT only |
Initial onset (within last 3 months) |
Neck |
OT only |
Recurrent (multiple episodes of <3 months) |
Index |
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Chronic (continuous duration >3 months) |
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Both PT and OT |
Back |
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Index |
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DASH
LEFS
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(other)
________
(other)
The date you want this Notification to begin:
Anticipated
Treatment Duration (weeks)
4 |
6 |
8 |
12 |
16 |
20 |
Patient Type
New to Your Office
Est’d, new to ACN Group
Est’d, new injury
Est’d, new episode Est’d, continuing care
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Date of Surgery |
Cause of Current Episode |
Type of Surgery |
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Traumatic |
ACL Recon |
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Unspecified |
Work related |
Rotator Cuff/Labral Repair |
Repetitive |
Motor vehicle |
Tendon Repair |
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Spinal Fusion
Joint Replacement
6Other ___________________________
Anticipated Status After This Episode |
Diagnosis |
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MTB, no residuals, discharged |
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Clinical Primary |
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MTB, residuals, discharged |
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MTB, residuals, PRN/supportive care |
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Not at MTB, update tx goals/plan |
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Referred/transferred |
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Check If Applicable - add comments to the right
There are significant
Clinic Name |
Therapist Name and Specialty |
Tax ID |
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Clinic Address |
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State |
Zip |
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Clinic Phone Number
I declare that the above information is true and accurate to the best of my knowledge. It is my professional judgment that my treatment plan is not contraindicated for this patient. I have discussed the above condition, prognosis following this plan of care, and have established appropriate and realistic goals with the patient.
Therapist Signature |
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Date |
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Effective Date |
Reference Number |
Overlap |
ACN Group Use Only
rev 05/18/06