Get the free custom afo / kafo order form - Tillges Technologies
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CUSTOM AFO / KARO
ORDER FORM
Order Date:Date Needed:PO#:BILLING INFORMATION
Facility:Contact Name:Address:City:State:Phone:Fax:Email:SHIPPING Information:Same as BillingFacility:Contact Name:Address:City:Phone:State:Fax:Zip:Email:SHIPPING
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How to fill out custom afo kafo order
How to fill out custom afo kafo order
01
To fill out custom AFO KAFO order, follow these steps:
02
Start by gathering all the necessary information about the patient, such as their name, address, and contact details.
03
Specify the type of AFO KAFO needed for the patient.
04
Provide detailed measurements of the patient's leg or arm, depending on the type of orthosis required.
05
Include any specific modifications or adjustments needed for the orthosis.
06
Clearly state the diagnosis or reason for prescribing the custom AFO KAFO.
07
Attach any relevant medical documentation or reports supporting the need for the orthosis.
08
Indicate any special requirements or preferences for materials, colors, or design.
09
Fill out the healthcare professional's information, including name, title, and contact details.
10
Double-check all the information provided for accuracy and completeness before submitting the order.
11
Submit the completed custom AFO KAFO order to the appropriate orthotics and prosthetics provider or manufacturer.
Who needs custom afo kafo order?
01
Custom AFO KAFO orders are typically needed for individuals with certain medical conditions or physical impairments.
02
These may include patients with neurological disorders such as cerebral palsy or multiple sclerosis, those with foot or ankle deformities, or individuals with limb length discrepancies.
03
Ultimately, the need for a custom AFO KAFO order is determined by a healthcare professional specializing in orthotics and prosthetics, based on the patient's specific requirements and clinical evaluation.
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What is custom afo kafo order?
Custom AFO KAFO order is a request for custom-made ankle-foot and knee-ankle-foot orthoses used to support and align the foot, ankle, and knee.
Who is required to file custom afo kafo order?
Healthcare professionals, such as physicians, physical therapists, or orthotists, are required to file custom AFO KAFO orders based on the patient's condition and needs.
How to fill out custom afo kafo order?
To fill out a custom AFO KAFO order, healthcare professionals need to provide detailed information about the patient's diagnosis, specific measurements, and functional goals.
What is the purpose of custom afo kafo order?
The purpose of custom AFO KAFO order is to provide patients with customized orthotic devices that can help improve mobility, stability, and overall function.
What information must be reported on custom afo kafo order?
The custom AFO KAFO order must include the patient's name, date of birth, diagnosis, specific measurements, functional goals, and any other relevant information.
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