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CUSTOM MADE FOOT ORTHOTIC
WAIVER
The doctor has prescribed custom manufactured prescription functional or
accommodate orthotic foot devices which are medically necessary for the
treatment of several
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How to fill out custom made foot orthotic

How to fill out custom made foot orthotic
01
To fill out a custom made foot orthotic, follow these steps:
02
Start by placing the orthotic on a flat surface.
03
Take a pen or marker and mark the areas that need to be filled out, such as the arch support or any specific modifications.
04
Remove the orthotic from the shoe or insert if applicable.
05
Fill out the marked areas with the desired material, such as foam or putty.
06
Use a spatula or similar tool to smooth out the filled areas and ensure they are even.
07
Allow the material to dry or cure as instructed by the manufacturer.
08
Once dry, place the orthotic back in the shoe or insert and test for comfort and proper fit.
09
Make any necessary adjustments or refinements to the filling if needed.
10
Repeat the process for the other foot if required.
11
Finally, wear the custom made foot orthotics and enjoy the enhanced support and comfort they provide.
Who needs custom made foot orthotic?
01
Custom made foot orthotics are beneficial for individuals who experience various foot, leg, or lower body conditions, such as:
02
- Flat feet or fallen arches
03
- Overpronation or underpronation
04
- Plantar fasciitis
05
- Bunions
06
- Heel spurs
07
- Diabetic foot problems
08
- Arthritis
09
- Sporting injuries
10
These conditions can cause pain, discomfort, or instability. Custom made foot orthotics help provide proper support, alignment, and cushioning, alleviating symptoms and promoting better foot function.
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What is custom made foot orthotic?
Custom made foot orthotic is a shoe insert that is specially made to support and align the foot in a specific way.
Who is required to file custom made foot orthotic?
Custom made foot orthotic must be filed by healthcare providers who prescribe or dispense them to patients.
How to fill out custom made foot orthotic?
Custom made foot orthotic should be filled out by providing detailed information about the patient, the type of orthotic prescribed, and any other relevant details.
What is the purpose of custom made foot orthotic?
The purpose of custom made foot orthotic is to provide support, alignment, and relief for foot conditions such as plantar fasciitis, flat feet, and high arches.
What information must be reported on custom made foot orthotic?
Information that must be reported on custom made foot orthotic includes patient details, diagnosis, prescription details, and any specific customization requirements.
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