Get the free Lower Extremity Custom Order Form - bKineMedicb

FOR ORTHOTICS ONLY Kinematic Concepts, Inc. P.O. Box 3220 Blue Jay, CA 92317 Phone: (909× 3373449 Fax: (909× 4980300 Web: www.KineMedic.com Lower Extremity Custom Order Form Patient Information

How to fill out lower extremity custom order

How to fill out a lower extremity custom order:

1. Begin by gathering all necessary information about the patient, such as their name, contact information, and any relevant medical history.
2. Specify the type of lower extremity custom device needed, whether it's an orthotic (for support) or a prosthetic (for replacing a missing limb).
3. Note any specific measurements required, such as the length and width of the limb, the angle of the joints, or any other specifications.
4. Indicate the desired materials for the custom device, considering factors like durability, flexibility, and comfort.
5. Provide details about any additional features or modifications needed, such as cushioning, adjustable straps, or specific alignment requirements.
6. Include any special instructions or preferences from the patient, such as color preferences or personal customization requests.
7. Double-check that all information provided is accurate and complete before submitting the order.
8. Remember to add any necessary supporting documentation, such as medical records or prescription forms.
9. Ensure that the order form is signed and dated by the healthcare professional responsible for overseeing the patient's care.

Who needs a lower extremity custom order?

1. Patients with congenital limb abnormalities who require orthotics or prosthetics to aid with mobility and support.
2. Individuals who have experienced trauma or injury resulting in the loss or impairment of a lower limb and require a prosthetic limb for assistance.
3. People with certain medical conditions such as peripheral arterial disease or diabetic neuropathy, who may benefit from orthotics to improve blood flow or alleviate pressure points in the feet and legs.
4. Athletes or individuals involved in physically demanding activities who may require specialized orthotics or prosthetics to enhance performance and prevent injury.
5. Some individuals with chronic conditions like arthritis or cerebral palsy who may require orthotics to improve stability and optimize their functional ability.
6. People undergoing rehabilitation after surgery or undergoing treatment for conditions affecting the lower extremities.
7. Anyone who experiences discomfort, pain, or difficulty with daily activities related to their lower extremities and would benefit from a custom-designed solution.

For pdfFiller’s FAQs

What is lower extremity custom order?

Lower extremity custom order is a request for custom-made orthotic devices for the lower body.

Who is required to file lower extremity custom order?

Healthcare professionals such as physicians, podiatrists, or orthopedic specialists are required to file lower extremity custom orders.

How to fill out lower extremity custom order?

Lower extremity custom orders must be filled out with detailed information about the patient's condition, measurements, and specific device requirements.

What is the purpose of lower extremity custom order?

The purpose of lower extremity custom order is to provide patients with customized orthotic devices that meet their individual needs.

What information must be reported on lower extremity custom order?

Information such as patient demographics, diagnosis, detailed measurements, specific device requirements, and healthcare provider information must be reported on lower extremity custom orders.

How do I make changes in lower extremity custom order?

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