Get the free Fillauer Upper Extremity Prosthetics

MEASUREMENT FORM Filler Upper Extremity Prosthetics Practitioner Tel: 800.251.6398 Fax: 423.698.6076 2710 Nicola Highway Chattanooga, TN 37406 Branch Name PO# Date: Ship Via: Address City State Zip

How to fill out fillauer upper extremity prosformtics

How to fill out Fillauer Upper Extremity Prosthetics:

1. Start by gathering all necessary information and forms. This typically includes the patient's personal details, insurance information, and any relevant medical documentation. Make sure you have the correct paperwork provided by Fillauer for the specific upper extremity prosthetic being used.
2. Begin by filling out the patient's personal details. This may include their full name, date of birth, address, contact information, and any other necessary identification details. Ensure that all information is accurate and up-to-date.
3. Next, proceed to the insurance section of the form. Provide the patient's insurance carrier, policy number, and any other requested insurance information. If the patient has multiple insurance coverages, make sure to provide details for each one.
4. The medical documentation section is crucial as it helps in determining the medical necessity for the Fillauer Upper Extremity Prosthetic. Include any relevant medical history, diagnoses, treatment plans, and physician's notes. Attach any supporting documents, such as X-rays or prescriptions, if required.
5. If there is a section for previous prosthetic usage, fill in the details about any prior upper extremity prosthetics the patient has used. Include the make, model, and reason for discontinuation, if applicable.
6. Some forms may include a section for measurements and specific requirements. This is where you would record any measurements needed for the fitting of the prosthetic. Double-check the form to ensure you have provided accurate measurements.
7. Finally, review the form for completeness and accuracy. Ensure that all required fields are filled out and all attached documents are included. Make sure the patient has signed any necessary consent forms or agreements.

Who needs Fillauer Upper Extremity Prosthetics:

1. Individuals with upper extremity limb loss or limb deficiency may require Fillauer Upper Extremity Prosthetics. This can include those who have undergone amputations due to accidents, trauma, birth defects, or medical conditions.
2. People who require improved functionality and mobility in their daily lives may benefit from Fillauer Upper Extremity Prosthetics. These prosthetics are designed to provide support, enhance grip strength, and assist with activities of daily living.
3. Fillauer Upper Extremity Prosthetics may be suitable for individuals who wish to regain independence and resume activities that were hindered by upper limb loss or deficiency. These prosthetics can help with tasks such as self-care, work, sports, and hobbies.

Remember to consult with a healthcare professional or prosthetist who specializes in upper extremity prosthetics to determine the specific needs and suitability for Fillauer Upper Extremity Prosthetics.

For pdfFiller’s FAQs

What is fillauer upper extremity prosformtics?

Fillauer upper extremity prosthetics are customized devices designed to replace missing parts of the upper limb, such as arms or hands.

Who is required to file fillauer upper extremity prosformtics?

Individuals who have undergone an amputation or have a congenital limb deficiency may be required to file for Fillauer upper extremity prosthetics.

How to fill out fillauer upper extremity prosformtics?

To fill out Fillauer upper extremity prosthetics, individuals need to work with a prosthetist who will assess their needs, take measurements, and customize the prosthetic device.

What is the purpose of fillauer upper extremity prosformtics?

The purpose of Fillauer upper extremity prosthetics is to improve the function and appearance of individuals who have lost all or part of their upper limb.

What information must be reported on fillauer upper extremity prosformtics?

Information such as the individual's medical history, measurements of the residual limb, desired functionality of the prosthetic, and any special requirements or preferences should be reported on Fillauer upper extremity prosthetics form.

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