NC Delphi Ortho AFO Orthometry Form 2005-2025 free printable template

AFO OPTOMETRY FORM Today's Date: Patient: Facility: Age: Sex: Ht: Street: Diagnosis: City: State: Zip: Orthotic: Delivery Date: Phone Number: PO Number: Wt: MEASUREMENTS: Inches Centimeters Ankle

How to fill out afo measurement form

How to fill out NC Delphi Ortho AFO Orthometry Form

1. Obtain the NC Delphi Ortho AFO Orthometry Form from the healthcare provider or the official website.
2. Gather the patient's complete information, including their full name, date of birth, and contact information.
3. Measure the patient's limb according to the guidelines provided in the form, ensuring accuracy.
4. Fill in the measurements on the form, including leg length, calf circumference, and foot size.
5. Indicate any specific needs or considerations for the patient's AFO, such as stability or mobility requirements.
6. Review the completed form for accuracy and completeness.
7. Submit the form to the appropriate medical professional or orthotist for processing.

Who needs NC Delphi Ortho AFO Orthometry Form?

1. Patients who require an Ankle-Foot Orthosis (AFO) for conditions such as foot drop, instability, or other orthopedic issues.
2. Healthcare providers who prescribe AFOs for their patients to aid in mobility and rehabilitation.
3. Orthotists who need precise measurements and specifications to create a custom AFO.

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What is NC Delphi Ortho AFO Orthometry Form?

The NC Delphi Ortho AFO Orthometry Form is a standardized document used to collect and record the orthometric measurements required for the fabrication and fitting of Ankle-Foot Orthoses (AFOs) in accordance with patient needs.

Who is required to file NC Delphi Ortho AFO Orthometry Form?

Healthcare providers, including orthotists and physicians, who are prescribing or dispensing Ankle-Foot Orthoses (AFOs) for patients are required to file the NC Delphi Ortho AFO Orthometry Form.

How to fill out NC Delphi Ortho AFO Orthometry Form?

To fill out the NC Delphi Ortho AFO Orthometry Form, providers must follow step-by-step instructions, accurately record patient measurements, include details about the patient's diagnosis, and ensure all required fields are completely filled in and legible.

What is the purpose of NC Delphi Ortho AFO Orthometry Form?

The purpose of the NC Delphi Ortho AFO Orthometry Form is to ensure that accurate and comprehensive measurements are captured to facilitate the proper design and fitting of AFOs, thus improving patient outcomes and compliance.

What information must be reported on NC Delphi Ortho AFO Orthometry Form?

The NC Delphi Ortho AFO Orthometry Form must report patient demographics, orthometric measurements such as limb length and circumference, clinical evaluation findings, prescription details from the healthcare provider, and any special instructions pertinent to the orthosis.