Get the free MINNESOTA BOOT CUSTOM AFO ORDER FORM -

MINNESOTA BOOT CUSTOM AFO 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:State:Phone:Fax:Email:Zip:SHIPPING

How to fill out minnesota boot custom afo

How to fill out minnesota boot custom afo

1. To fill out the Minnesota Boot Custom AFO, follow these steps:
2. Patient personal information: Fill out the patient's full name, address, phone number, and date of birth.
3. Prescription: Enter the prescribing physician's name, address, and phone number.
4. Diagnosis: Indicate the specific condition or reason for requiring the Minnesota Boot Custom AFO.
5. Measurements: Provide accurate measurements of the patient's foot, ankle, and leg as required.
6. Design preferences: Specify any design preferences or special instructions for the AFO.
7. Insurance information: Fill out the patient's insurance details, including policy number and any applicable authorizations.
8. Authorization and signature: The prescribing physician must sign and date the form, providing their authorization for the AFO.
9. Review and submission: Double-check all information for accuracy before submitting the completed form to the appropriate authority.

Who needs minnesota boot custom afo?

1. Minnesota Boot Custom AFO is typically needed by individuals who:
2. - Suffer from foot or ankle deformities or injuries
3. - Experience foot drop or other gait abnormalities
4. - Require ankle stabilization or support
5. - Have certain medical conditions like cerebral palsy or multiple sclerosis that affect mobility
6. - Need assistance with ambulation or walking due to muscle weakness or paralysis
7. It is essential that a healthcare professional evaluates each individual case to determine if the Minnesota Boot Custom AFO is necessary.

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