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Get the free FOOT AND ANKLE PRESCRIPTION FORM - Zero G Brace

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Rx: Custom Molded Ankle Foot Orthotic Doctor/Prescriber Name: ___ Patient Name: ___ Phone: ___ICN: ___ DOB: ___/___/___Quantity, Product and CPC Codes: ___ L1940 A semirigid molded plastic arthrosis
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How to fill out foot and ankle prescription

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How to fill out foot and ankle prescription

01
Obtain a prescription for foot and ankle orthotics from a medical professional such as a podiatrist or orthopedic specialist.
02
Provide the prescription to a qualified orthotics provider who can create custom orthotics based on the specifications in the prescription.
03
Ensure that the provider takes accurate measurements of the foot and ankle to create orthotics that fit properly and address any specific issues.
04
Choose the appropriate materials and design for the orthotics based on the recommendations of the medical professional and the provider.
05
Wait for the custom orthotics to be created and fitted to your foot and ankle before wearing them regularly.
06
Follow any additional instructions provided by the medical professional or orthotics provider for care and maintenance of the orthotics.

Who needs foot and ankle prescription?

01
Individuals with foot and ankle conditions such as plantar fasciitis, flat feet, high arches, arthritis, or injuries that require additional support and alignment.
02
Athletes who engage in high-impact activities that put stress on the foot and ankle joints and muscles.
03
People who spend long hours on their feet for work or other activities and would benefit from added comfort and support provided by orthotics.
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Foot and ankle prescription is a medical document issued by a healthcare provider to recommend specific treatment or equipment for conditions related to the foot and ankle.
Healthcare providers such as podiatrists, orthopedic surgeons, or primary care physicians are required to file foot and ankle prescriptions.
A foot and ankle prescription should include the patient's information, the recommended treatment or equipment, the duration of use, and the healthcare provider's signature.
The purpose of a foot and ankle prescription is to ensure that patients receive the appropriate treatment or equipment to address their foot and ankle conditions.
Patient's information, recommended treatment or equipment, duration of use, and healthcare provider's signature must be reported on foot and ankle prescription.
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