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SUBMIT PROSPECTUS BRACE FORM Outpatient/Fax 866.868.1890 | Email orders@surestep.net Customer Service 877.462.0711/MEASUREMENTSLast Name/Patient SCANS ARE REQUIREDFirst Name DOB// Makeweight FemaleHeightAccepted

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How to fill out pectus brace form

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Start by gathering all necessary information such as personal details, doctor's recommendations, and measurements.

02

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Who needs pectus brace form?

01

Individuals diagnosed with pectus excavatum or other chest wall deformities may need to fill out a pectus brace form.

02

This form is typically used by patients who are prescribed a pectus brace as part of their treatment plan.

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What is pectus brace form?

The pectus brace form is a medical device used to treat conditions such as pectus excavatum.

Who is required to file pectus brace form?

Patients who have been prescribed a pectus brace by their healthcare provider are required to file the pectus brace form.

How to fill out pectus brace form?

To fill out the pectus brace form, patients need to provide their personal information, healthcare provider information, and details about their prescription.

What is the purpose of pectus brace form?

The purpose of the pectus brace form is to document the use of the medical device and ensure proper monitoring and follow-up by healthcare providers.

What information must be reported on pectus brace form?

The pectus brace form must include the patient's name, date of birth, contact information, healthcare provider's name, prescription details, and any relevant medical history.

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