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STATEMENT OF NEED FOR THERAPEUTIC SHOES Patient Name: Address: MC#: Date of RX I CERTIFY THAT All the FOLLOWING STATEMENTS ARE TRUE: 1) This patient has diabetes mellitus. ICD9 CODE 2) This patient
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How to fill out diabeticshoesscriptdoc
How to fill out diabeticshoesscriptdoc:
01
Start by accessing the diabeticshoesscriptdoc form. This can usually be done online or through your healthcare provider's office.
02
Fill in your personal information accurately. This may include your name, date of birth, address, and contact details.
03
Provide information about your healthcare provider, such as their name, address, and contact information.
04
Specify the type of shoes or footwear you require due to your diabetes condition. This may involve selecting options for diabetic shoes, custom orthotics, or shoe inserts.
05
Indicate any additional accessories or modifications you may need for your shoes, such as heel lifts or adjustments for foot deformities.
06
Describe any specific foot conditions or complications related to your diabetes that need to be considered when selecting your footwear.
07
Mention any relevant insurance information if applicable, including policy numbers and any specific requirements or coverage limitations for diabetic shoes.
08
Review the completed form for accuracy and completeness before submitting it to your healthcare provider or the designated recipient.
Who needs diabeticshoesscriptdoc:
01
Individuals with diabetes who are experiencing foot problems or have a higher risk of foot complications due to their condition.
02
People who require specialized footwear to improve foot health, prevent ulcers, or alleviate foot pain caused by diabetes-related neuropathy or other complications.
03
Patients who have been recommended or prescribed diabetic shoes or footwear by their healthcare provider or medical professional for managing their diabetes and preventing potential foot problems.
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