Get Orthema Orthotic Prescription Form V2014.09.04

Filling out the Orthema Orthotic Prescription Form V2014.09.04 online is a straightforward process. This guide provides detailed, step-by-step instructions to help you complete the form efficiently and accurately.

Follow the steps to successfully complete the form online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering the patient details. Fill in the title, name, date of birth, height, and weight of the patient in the designated fields.
3. Next, provide information about the practitioner. Enter the practitioner's full name and location. Ensure this information is current and accurate.
4. Choose the payment method by ticking the appropriate box for cash, credit card, cheque, or CCSS.
5. Specify the diagnosis in the provided field. It should clearly state the condition requiring orthotic support.
6. Select the 3D capture method used. You can choose from foam impression box, plaster cast, 3D digital scan, or Orthema scan by ticking the corresponding box.
7. Fill in the dimensions required for orthotic fitting. Enter the sizes for pre-metatarsal supports, heel skives, pronation and supination wedges, as well as any other special modifications.
8. Complete the milling specifications section by selecting the block type, specifying shoe size and density, and detailing the arch support percentage for both left and right sides.
9. Select the covering material by ticking the preferred option from the list provided.
10. In the comments section, add any additional notes or specifications related to the prescription.
11. Finally, review all the entered information for accuracy. Once confirmed, proceed to save changes, download, print, or share the form as necessary.

Complete the Orthema Orthotic Prescription Form online today to ensure timely processing of your orthotic needs.