Get Account Information Custom Urethane Liners

Filling out the Account Information Custom Urethane Liners online is a crucial step in ensuring accurate and timely processing of custom liners for patients. This guide provides clear and supportive instructions on how to complete each section of the form effectively.

Follow the steps to successfully complete your form.

1. Press the ‘Get Form’ button to obtain the form and open it in the document editor.
2. Begin by entering the date and account number at the top of the form.
3. In the 'Bill To' section, fill in the phone number, fax number, email address, and ordered by fields as required.
4. Fill in the 'Ship To' section with the recipient's name, phone number, address, city, and state/zip code.
5. Specify the shipping options by checking the appropriate box for next day, 2-day, ground, or other methods.
6. Complete the 'Patient Information' section by writing the patient's first and last name clearly. Include the appropriate limb information and select whether it is for the left or right limb or transtibial/transfemoral.
7. Choose the appropriate type of custom liner, including options for Custom Harmony® or Custom Urethane Liner, and indicate the desired wall thickness, exterior textile cover, locking mechanism, and any additives.
8. For the measurement length, indicate the length of the residual limb from MPT to the distal end and circle the correct measurement unit (cm or in).
9. Lastly, ensure all completed sections are reviewed for accuracy, and sign where necessary.
10. Once filled, you can save changes, download, print, or share the completed form as needed.

Complete your documents online to streamline your order process.