Get the free Above Knee Prosthesis - Orthomerica

Above Knee Prosthesis Date 6333 North Orange Blossom Trail, Orlando FL 32810 www.orthomerica.com phone 8777378444 fax 8777378445 PATIENT INFO (PHI) Remarks/Additional Prosthetic Components Last Name

How to fill out above knee prosformsis

How to Fill Out Above Knee Prosthesis:

1. Gather necessary information: Before filling out the form, make sure you have all the required information such as personal details, medical history, and any specific preferences or needs.
2. Begin with personal details: Start by providing your full name, date of birth, contact information, and other relevant personal details requested in the form.
3. Medical history: Fill out the section that asks for your medical history related to your above knee prosthesis, including any surgeries or procedures you have undergone, previous prostheses used, and any complications or issues you may have experienced.
4. Current condition: Provide detailed information about your current physical condition, including the reason for needing an above knee prosthesis, the extent of your mobility limitations, and any additional conditions or injuries that could impact the prosthetic fitting.
5. Functional requirements: Indicate any specific functional requirements you have for the prosthetic, such as the need for adjustable height, stability features, or specialized components that may enhance your mobility and quality of life.
6. Preferences: If you have any preferences regarding the design, materials, or aesthetics of the prosthesis, make sure to mention them in the form. This can include factors like color, weight, or any other personal preferences.
7. Financial and insurance information: Fill out the sections related to your insurance coverage, financial responsibilities, and payment options. Provide accurate information to ensure a smooth process.
8. Signature and consent: Read the terms and conditions thoroughly, and if you agree, sign and date the form, indicating your consent to proceed with the prosthetic fitting process.

Who Needs Above Knee Prosthesis:

1. Amputees: Individuals who have undergone above knee amputation due to various reasons, such as trauma, accidents, or medical conditions like cancer or vascular diseases, may require an above knee prosthesis for restoration of mobility.
2. Patients with limb loss or deformity: People who have congenital limb deficiencies or conditions that cause limb loss or deformity may benefit from an above knee prosthesis to regain mobility and improve their overall functionality.
3. Those seeking improved quality of life: Above knee prosthesis can significantly enhance the quality of life for individuals with mobility limitations by enabling them to perform daily activities, engage in recreational activities, and regain independence.
4. Athletes or physically active individuals: Above knee prostheses designed for active individuals can help athletes, sports enthusiasts, or individuals with physically demanding lifestyles to continue their activities efficiently and effectively.

Remember to consult with a healthcare professional or prosthetist for accurate guidance and personalized recommendations regarding above knee prosthesis.

For pdfFiller’s FAQs

What is above knee prosformsis?

Above knee prosthesis is a type of artificial limb that replaces an amputated leg above the knee.

Who is required to file above knee prosformsis?

Patients who have undergone above knee amputation and require a prosthesis are required to file for above knee prosformsis.

How to fill out above knee prosformsis?

Above knee prosformsis can be filled out by consulting with a prosthetist who specializes in designing and fitting above knee prostheses.

What is the purpose of above knee prosformsis?

The purpose of above knee prosformsis is to provide amputees with mobility, stability, and functionality by replacing the missing part of the leg with an artificial limb.

What information must be reported on above knee prosformsis?

The information reported on above knee prosformsis may include patient's medical history, amputation details, prosthetic requirements, and insurance information.

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