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91 Rev. B Medial Malleous SMO Height Default White Default Color Finished Foot Length Sulcus Full Foot. FUZION SMO Date SupraMalleolar 586. 30 6333 North Orange Blossom Trail Orlando FL 32810 www. orthomerica.com phone 877-737-8444 fax 877-737-8445 PATIENT INFO PHI Remarks Last Name / ID First Name Gender Male Female Age Height Diagnosis SHIPPING INFORMATION Service Shipping Company Practitioner Phone/Fax Facility PO Number UPS FedEx Other Ground 2 Day Air Overnight Need by Ship to Address...
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Include relevant medical history
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Who needs orthomerica forms?
01
Orthopedic professionals
02
Orthotic and prosthetic practitioners
03
Patients requiring orthotic or prosthetic devices
04
Individuals with musculoskeletal conditions or injuries
05
Healthcare providers involved in orthopedic treatment
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What is orthomerica forms?
Orthomerica forms are medical forms used to document orthotic and prosthetic services provided to patients.
Who is required to file orthomerica forms?
Orthopedic practitioners, prosthetists, and orthotists are required to fill out and file orthomerica forms for their patients.
How to fill out orthomerica forms?
Orthomerica forms can be filled out manually or electronically, and must include details about the patient's condition, treatment plan, and equipment used.
What is the purpose of orthomerica forms?
The purpose of orthomerica forms is to ensure proper documentation of orthotic and prosthetic services for quality of care, billing, and insurance purposes.
What information must be reported on orthomerica forms?
On orthomerica forms, information such as patient demographics, medical history, diagnosis, treatment plan, and equipment used must be reported.
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