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This document serves as a certification form required by insurance companies for billing diabetic shoes and inserts. It must be completed and signed by a treating diabetic doctor (MD/DO) to confirm that the patient meets the necessary conditions for therapeutic footwear due to diabetes.
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How to fill out formrapeutic shoe statement

01
Obtain the Therapeutic Shoe Statement form from a certified provider or online.
02
Fill out patient information, including name, address, and insurance details.
03
Provide the diagnosis that necessitates the use of therapeutic shoes.
04
List any relevant medical history, especially foot-related conditions.
05
Specify the type of therapeutic shoes required (e.g., depth shoes, custom inserts).
06
Include any additional information or requirements as specified by the healthcare provider.
07
Ensure that the form is signed and dated by a qualified medical professional.
08
Submit the completed form to the appropriate insurance or medical facility.

Who needs formrapeutic shoe statement?

01
Individuals with diabetes who have foot complications.
02
Patients with severe calluses or bunions that require specialized footwear.
03
People with foot deformities that need custom fittings.
04
Those recovering from foot surgeries that necessitate special shoes.
05
Individuals with certain neurological conditions affecting foot stability.
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The formrapeutic shoe statement is a document used to certify the medical necessity of therapeutic shoes for individuals with specific foot-related medical conditions.
Healthcare providers or suppliers who are prescribing or dispensing therapeutic shoes for patients are required to file the formrapeutic shoe statement.
To fill out the formrapeutic shoe statement, the provider must provide patient information, diagnosis, and details of the prescribed shoes, ensuring all necessary certifications are signed.
The purpose of the formrapeutic shoe statement is to ensure that patients receive appropriate footwear for their medical needs and to facilitate reimbursement from insurance companies.
The statement must report the patient's information, diagnosis, type of therapeutic shoes being prescribed, and the provider's certification of medical necessity.
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