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This document serves as an order form for custom diabetic inserts, specifically coded as K0903 and L5000. It includes sections for billing and shipping information, practice details, patient information, and specifications for the inserts such as quantity, type, and customization options. Additional details regarding foot impressions and shipments to Orthotic Holdings are also provided.
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How to fill out custom diabetic insert order
How to fill out custom diabetic insert order
01
Gather patient information: Collect the patient's name, contact details, and insurance information.
02
Obtain a prescription: Ensure that you have a valid prescription from a healthcare provider for custom diabetic inserts.
03
Measure foot dimensions: Use a foot measuring device to accurately measure the length, width, and arch of the patient's feet.
04
Choose the material: Select the appropriate materials for the diabetic inserts based on the patient's needs and any special requirements.
05
Complete the order form: Fill out the custom order form with all gathered information, including measurements, materials, and any specific instructions.
06
Review and confirm: Double-check all information for accuracy before submitting the order.
07
Submit the order: Send the completed order form to the manufacturer or supplier for processing.
Who needs custom diabetic insert order?
01
Individuals diagnosed with diabetes who suffer from foot complications or require additional support in their footwear.
02
Patients who have experienced foot injuries or neuropathy related to diabetes.
03
Healthcare providers looking to improve the comfort and mobility of diabetic patients through customized foot inserts.
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What is custom diabetic insert order?
A custom diabetic insert order is a specific request for diabetic shoe inserts tailored to the individual's foot shape and medical needs, ensuring proper fit and support.
Who is required to file custom diabetic insert order?
Healthcare professionals, such as doctors or podiatrists, are typically required to file a custom diabetic insert order for their patients who need custom inserts.
How to fill out custom diabetic insert order?
To fill out a custom diabetic insert order, the prescribing healthcare provider should complete the order form with the patient's information, foot measurements, medical history, and specific requirements for the inserts.
What is the purpose of custom diabetic insert order?
The purpose of a custom diabetic insert order is to provide individuals with diabetes personalized foot support to prevent complications and improve comfort while walking.
What information must be reported on custom diabetic insert order?
The custom diabetic insert order must report patient name, healthcare provider details, measurements of the feet, diagnosis, and any specific features required for the inserts.
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