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BRACE
ORDER FORMDateLab to Call Doctor:
Date Received in Lab:Patient Name:Height:Doctors Name:
535 N 1300 E St. George, UT 84770
(800) 3015835
Phone:
(435) 2518506
Fax: (435) 2518505
www.fdmotion.comCity:State:Phone:Fax:Weight:Left
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How to fill out brace order form v13
How to fill out brace order form v13
01
Start by opening the brace order form v13.
02
Fill out the patient's information section, including their name, date of birth, and contact details.
03
Provide the necessary medical information such as diagnosis, treatment plan, and relevant ICD-10 codes.
04
Specify the type of brace needed and any additional features or customization required.
05
Indicate the billing information including insurance details and any pre-authorization requirements.
06
Include any supporting documentation such as clinical notes, imaging reports, or previous brace orders.
07
Review the completed form for accuracy and make any necessary corrections or additions.
08
Sign and date the form, indicating your approval and responsibility for the order.
09
Submit the completed brace order form v13 to the appropriate department or supplier for processing.
Who needs brace order form v13?
01
Brace order form v13 is needed by healthcare professionals, such as physicians, orthotists, or physical therapists, who are prescribing or requesting braces for their patients.
02
It is also required by suppliers and billing organizations involved in the provision of braces and related healthcare services.
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What is brace order form v13?
brace order form v13 is a document used to request braces for medical purposes.
Who is required to file brace order form v13?
Healthcare providers and medical professionals are required to file brace order form v13.
How to fill out brace order form v13?
Brace order form v13 must be filled out with the patient's information, medical diagnosis, and the type of brace being requested.
What is the purpose of brace order form v13?
The purpose of brace order form v13 is to provide documentation for the medical necessity of braces.
What information must be reported on brace order form v13?
Information such as patient's name, date of birth, medical diagnosis, type of brace needed, and healthcare provider's information must be reported on brace order form v13.
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