Get the free BOSTON (H)KAFO ORDER FORM

BOSTON (H)KARO ORDER FORM Date:Due Date:Contact Ship To:Account:Misaddress:PO#:Phone:Ship Via:Fax:City:State(1 of 2)PATIENT INFORMATION CastScanExisting Roadside:LeftRightBilateralDevice Type:KOKAFOHKAFOPatient

How to fill out boston hkafo order form

How to fill out boston hkafo order form

1. Start by entering your personal information in the designated sections of the form, such as your full name, address, and contact details.
2. Specify the reason for ordering a Boston HKAFO (Hip-Knee-Ankle-Foot Orthosis) in the relevant section.
3. Provide accurate measurements of your body, including waist circumference, leg length, and foot size, as per the instructions given.
4. Indicate any specific modifications or customizations required for the orthosis, if applicable.
5. Clearly state the type of materials you prefer for the Boston HKAFO, such as plastic, metal, or a combination.
6. Detail any additional accessories or components that you would like to be included with the orthosis, such as joint locks or straps.
7. Include any relevant medical information or documentation that may be necessary for the fabrication and fitting of the Boston HKAFO.
8. Review all the provided information thoroughly to ensure accuracy and completeness.
9. Sign and date the order form to certify that the information provided is correct and that you authorize the production of the Boston HKAFO based on the given specifications.
10. Submit the completed order form to the designated healthcare provider or manufacturer, following their specific submission procedures.

Who needs boston hkafo order form?

1. The Boston HKAFO order form is typically needed by individuals who require a custom-made orthosis to provide stability and support to their hip, knee, ankle, and foot.
2. These individuals may have conditions such as spinal cord injuries, neuromuscular disorders, or musculoskeletal deformities that necessitate the use of a Boston HKAFO.
3. Healthcare professionals and orthotists who are involved in the fabrication and fitting of Boston HKAFOs also require the order form to accurately gather the necessary information and specifications from the patients.

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What is boston hkafo order form?

The Boston HKAFO Order Form is a document used to prescribe, order, and provide medical justification for a Boston hip-knee-ankle-foot orthosis (HKAFO), which is a device designed to support patients with lower limb disabilities.

Who is required to file boston hkafo order form?

Healthcare providers, including physicians and orthotists, are required to file the Boston HKAFO order form when prescribing the orthosis for patients who need this support.

How to fill out boston hkafo order form?

To fill out the Boston HKAFO order form, a healthcare provider must provide patient information, specify the type of orthosis being prescribed, include medical justification, and sign the form to indicate their approval.

What is the purpose of boston hkafo order form?

The purpose of the Boston HKAFO order form is to formally request the fabrication or fitting of the orthosis for a patient, ensuring there is adequate documentation for insurance reimbursement and medical necessity.

What information must be reported on boston hkafo order form?

The information that must be reported on the Boston HKAFO order form includes the patient's name, date of birth, diagnosis, type of HKAFO requested, and healthcare provider details, along with any medical necessity justifications.