Get Orthoses Request And Justification

This guide provides clear and supportive instructions for completing the Orthoses Request And Justification form online. Each step is designed to assist users in accurately filling out the required sections of the form.

Follow the steps to successfully complete your orthoses request.

1. Click ‘Get Form’ button to access the Orthoses Request And Justification form and open it for editing.
2. Begin with Section 1 – Client Information. Fill in the client's given name, surname, birth date, phone number, and personal health number. Ensure you provide the client's street address and city, alongside the postal code.
3. Indicate if the client is eligible to access medical equipment under the Employment and Assistance regulations by selecting 'Yes' or 'No.' Also, check if there are other resources available to provide the requested orthosis.
4. In the same section, provide an explanation regarding any alternative resources available for orthoses through organizations like ICBC, WorkSafeBC, or private insurance.
5. The worker must sign and provide their office code, branch, and worker number. Include the date of signing in the format YYYY MMM DD.
6. Proceed to Section 2 – Medical or Nurse Practitioner Recommendation. Here, medical practitioners should describe the patient's medical condition and recommend the type of orthosis needed.
7. Indicate if a custom-made orthosis is required and whether the orthosis is a knee brace that will be needed for at least 6 hours per day by selecting 'Yes' or 'No.'
8. Ensure the medical practitioner signs, adds their phone number, and the date signed in the format YYYY MMM DD.
9. Next, move to Section 3 – Assessment. Complete this by specifying the orthoses' requirements and how the prescribed item will assist with joint motion or support.
10. Check any relevant purposes for the orthosis such as prevention of surgery, post-surgical treatment, or assistance in physical healing. Provide explanations as required.
11. If applicable, indicate if the custom-made foot orthotic will be made from a hand cast mold and provide related explanations.
12. Conclude with any additional relevant information regarding the current device or condition. Ensure the clinician providing treatment signs, includes their printed name, position/title, and professional registration number if necessary.
13. Finally, submit the completed form to the Ministry of Social Development and Social Innovation at the provided address or as instructed.

Complete your Orthoses Request And Justification form online today to ensure you receive the necessary support.