Get the free Custom Plastic AFO Order Form - Acor

ACTOR Orthopedic 18530 S. Miles Parkway Cleveland, OH 44128 Phone: 8002372267 Option 1, Fax: 2165879529 PLASTIC ORTHOTICS Patient Name: Company: DX: Address: Age: City: State: Zip: Left Height: Right

How to fill out custom plastic afo order

How to fill out a custom plastic AFO order:

1. Begin by gathering all necessary information: the patient's name, contact information, and any relevant medical history or prescription details.
2. Determine the specific measurements required for the custom plastic AFO and ensure accurate measurements are taken.
3. Choose the appropriate design or style of AFO based on the patient's needs and the healthcare professional's recommendation.
4. Include any additional specifications or modifications needed, such as specific material preferences or specialized features.
5. Provide all relevant billing and insurance information, including any required authorization or referral forms.
6. Double-check all entered information for accuracy before submitting the order.
7. Send the completed order form to the appropriate manufacturer or supplier through the preferred method (e.g., email, fax, or online portal).
8. Follow up with the manufacturer or supplier to confirm that the order has been received and to inquire about the estimated turnaround time.

Who needs custom plastic AFO order:

1. Individuals with foot or ankle injuries or deformities requiring additional support or stabilization.
2. Patients with certain medical conditions like cerebral palsy, multiple sclerosis, or stroke, that affect their ability to walk or maintain proper foot alignment.
3. Athletes or active individuals looking for specialized support and protection for their feet and ankles during physical activities.
4. People with certain foot conditions such as drop foot, plantar fasciitis, or severe pronation that require orthotic intervention.
5. Individuals seeking a personalized and comfortable solution for addressing foot-related problems or improving mobility.

For pdfFiller’s FAQs

What is custom plastic afo order?

Custom plastic afo order is a specialized order for a plastic ankle-foot orthosis (AFO) that is customized to fit a specific individual's needs.

Who is required to file custom plastic afo order?

The healthcare provider or facility that is prescribing or supplying the custom plastic AFO is required to file the order.

How to fill out custom plastic afo order?

The custom plastic AFO order should be filled out with the patient's name, contact information, specific measurements and details of the AFO, as well as the prescribing healthcare provider's information.

What is the purpose of custom plastic afo order?

The purpose of a custom plastic AFO order is to ensure that the AFO is tailored to the individual patient's needs and provides the necessary support and functionality.

What information must be reported on custom plastic afo order?

The custom plastic AFO order must include the patient's personal information, details of the AFO design and measurements, as well as the prescribing healthcare provider's information.

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