Get the free Limb Prosthetics Referral Form - rnoh.nhs.uk - rnoh nhs
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Limb Prosthetics Referral Form Prosthetic Rehabilitation Unit, Royal National Orthopedic Hospital, Buckley Hill, Stan more HA7 4LP Tel: 020 8909 5505 Fax: 020 8909 5142 Please ensure you complete
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How to fill out limb prosthetics referral form
How to fill out a limb prosthetics referral form:
01
Start by ensuring that you have the correct referral form from your healthcare provider or prosthetic specialist.
02
Fill out your personal information accurately and completely. This typically includes your full name, address, phone number, and date of birth.
03
Provide your medical history related to your limb amputation and any other relevant medical conditions. This helps the prosthetic specialist understand your unique needs and requirements.
04
Include information about your current prosthetic device, if applicable. This includes the make, model, and any modifications that have been made.
05
Describe any specific goals or concerns you have for your new limb prosthetic. This could include things like improving mobility, reducing pain, or enhancing overall functionality.
06
If you have any preferences or requirements for your prosthetic device, make sure to communicate them clearly. This could involve aspects such as color, material, or additional features.
07
Provide information about your insurance coverage, including your insurance company name, policy number, and any specific requirements or limitations.
Who needs a limb prosthetics referral form?
01
Individuals who have undergone limb amputation and are in need of a prosthetic device may require a limb prosthetics referral form.
02
Patients who are seeking assistance from a prosthetic specialist or healthcare provider to evaluate, recommend, or fit them with a prosthetic limb may need to complete a referral form.
03
A limb prosthetics referral form may also be required for individuals seeking insurance coverage or reimbursement for their prosthetic device. This is to ensure that the appropriate documentation and justification are provided to the insurance company.
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