Get Activa M391 2014-2026

The Activa M391 form is essential for ordering made-to-measure hosiery for individuals experiencing lymphoedema and chronic oedema. This guide provides a clear, step-by-step process to help you complete the form effectively.

Follow the steps to accurately complete the Activa M391 form.

1. Click ‘Get Form’ button to obtain the Activa M391 form and open it in the document editor.
2. Begin by filling out the pharmacy or clinic’s details at the top of the form, including the name, contact name, account number, branch number, and address.
3. Fill in the patient's details including their name or reference number, date of measurement, and order date. Ensure all entries are accurate.
4. Proceed to measure the left and right legs as specified in the measurement instructions. Record the corresponding length and circumference for each measurement point provided.
5. If ankle pads are required, indicate the specifications by measuring as directed and selecting the appropriate options for left or right pads.
6. Specify the quantity and type of garment required under main garment details. Choose between ActiLymph MTM Ease and ActiLymph MTM Dura, along with the respective class and colour.
7. Complete optional extras by selecting any additional requirements such as toe options or silicone top bands, ensuring to follow the instructions.
8. After ensuring all sections are completed and checked for accuracy, save the form, and download it for submission.
9. Send the completed order form via the preferred method: email, fax, or post, as indicated at the bottom of the document.

Take action today by completing your Activa M391 form online!