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First , Coumadin has a narrow therapeutic range that has to be determined based on the particular patient 's condition ; too little Coumadin will be ineffective for a patient 's condition while too much Coumadin exposes a patient to risk of bleeding . They then select appropriate equipment settings and direct the patient to move into positions that will provide the best view . Dr. McElligott carries out a full assessment of the patient to examine their way of thinking and they will then work out a programme to help change that way of thinking . Doctors and therapists need to know what those tools are , and if they do n't , have the responsibility of referring the patient to someone who does . These tumors may make it difficult for the patient to move the mouth and jaw normally . Commonly , this new form is guttate psoriasis , which is much more severe and cosmetically problematic than the preexisting plaque type.Many of the therapies for psoriasis manipulate the function of the immune system and expose the patient to risk of severe infections while blunting the body 's response . The pedals and display easily glide toward and away from the patient and lock in place , making it unnecessary for the patient to move , but also allowing a therapist to move the cycle out of the way should assistance be needed . The presence of an enlarged and tender postauricular node will sometimes prompt the referring physician to send the patient to you with a diagnosis of " mastoid . " It was almost as if one lost face when referring a patient to someone in a different specialty . Even if you do n't send electronic transactions from your practice , an NPI may be needed to identify you in other situations , such as when another provider wants to refer a patient to you , a pharmacy needs to bill for drugs you prescribed , a hospital needs to bill for a patient you treated or admitted , or a lab needs to bill for services you ordered . If a therapist feels for whatever reason that he cannot treat someone of this condition , he has an obligation to refer the patient to someone who will .