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Transtibial Silicone Custom Liner from Measurement Form Customer number Contact Date Customer Shipping address (if different from customer address) Company Street Postal code/city Postal code/city

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How to fill out transtibial prosformtic measurement form

How to fill out transtibial measurement form:

01

Start by entering the patient's personal information, such as their name, date of birth, and contact information.

02

Next, record the patient's medical history, including any previous injuries or surgeries related to the lower limb.

03

List any current medications the patient is taking that may affect their limb function or healing process.

04

Move on to documenting the measurements for the affected limb. This includes measuring the circumference at specific points, such as the distal tibia, distal fibula, and the patella.

05

Measure the length of the residual limb from the distal end to the epicondyle.

06

If applicable, measure the height of the tibial tuberosity and the length of the patellar tendon.

07

Finally, make a note of any special considerations or specific requirements the patient may have, and indicate the desired outcome or goal of the prosthetic fitting.

Who needs transtibial measurement form:

01

Patients who have undergone or are about to undergo transtibial amputation surgery.

02

Prosthetists or healthcare professionals responsible for creating and fitting the prosthetic limb.

03

Insurance companies or funding agencies that require accurate measurement documentation for coverage approval or reimbursement purposes.

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What is transtibial measurement form?

The transtibial measurement form is a document used by healthcare professionals to record specific measurements for patients who have undergone a transtibial amputation, providing essential data for prosthetic fitting.

Who is required to file transtibial measurement form?

Healthcare professionals, particularly prosthetists, are required to file the transtibial measurement form when assessing a patient for a prosthetic limb following transtibial amputation.

How to fill out transtibial measurement form?

To fill out the transtibial measurement form, practitioners should accurately measure the residual limb length, circumference, and other relevant parameters, and document the details clearly in the designated sections of the form.

What is the purpose of transtibial measurement form?

The purpose of the transtibial measurement form is to ensure that all necessary measurements and data are recorded accurately to facilitate the proper design and fitting of a prosthesis for the patient.

What information must be reported on transtibial measurement form?

The information that must be reported includes the patient's identification details, measurement of the residual limb, any skin conditions or issues, and other pertinent health information that may affect the prosthetics fitting process.

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