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DETAILED WRITTEN PHYSICIAN ORDER ANKLE FOOT ARTHROSIS (MULTIPLES TYPE) SECTION A to be filled out by the supplier CERTIFICATION: () INITIAL () REVISED SUPPLIER: ORTHOTIC MEDICAL, INC. P.O. BOX 364

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What is mdorderl4396doc?

mdorderl4396doc is a form used for ordering medical supplies or equipment.

Who is required to file mdorderl4396doc?

Healthcare providers or facilities that need to order medical supplies or equipment are required to file mdorderl4396doc.

How to fill out mdorderl4396doc?

To fill out mdorderl4396doc, you need to provide information such as the type of supplies or equipment needed, quantities required, patient information, and contact details.

What is the purpose of mdorderl4396doc?

The purpose of mdorderl4396doc is to streamline the process of ordering medical supplies or equipment for healthcare providers or facilities.

What information must be reported on mdorderl4396doc?

Information such as the type of supplies or equipment needed, quantities required, patient information, and contact details must be reported on mdorderl4396doc.