Serving N Florida, S Alabama
Phone: 850-815-8800
Fax: 850-344-9900
office@orchardaba.com

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Now accepting clients in Crestview, FL

Client Demographics

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Female

Insurance Information

Medicaid

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Other Insurance

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Treatment History

Occupational Therapy

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No

Physical Therapy

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No

Speech Therapy

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No

Diagnostic Information

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Medications

Food or Drug Allergies

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Additional Forms

Assignment of Benefits and HIPAA

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