Get Becker Afo Orthometry Form

The Becker AFO Orthometry Form is designed to collect essential information for the fitting and fabrication of ankle-foot orthoses. This guide provides straightforward, step-by-step instructions on how to complete the form online, ensuring accuracy and thoroughness for the benefit of users.

Follow the steps to complete the form effectively.

1. Press the ‘Get Form’ button to access the Becker AFO Orthometry Form and open it in your designated editor.
2. Fill in today's date in the appropriate field at the top of the form.
3. Provide the patient's name in the 'Patient' section.
4. Indicate the facility name where the patient is being treated.
5. Record the patient's age, sex, and height.
6. Enter the patient's street address, city, state, and zip code.
7. Specify the diagnosis related to the patient's condition.
8. Fill in the name of the orthotist responsible for the case.
9. Include the desired delivery date for the orthosis.
10. Provide the contact phone number and purchase order (PO) number, if applicable.
11. Enter the patient's weight and continue to the measurements section.
12. Indicate any specific measurement details for the ankle, including conditions like varus, valgus, flexible, or rigid along with range of degrees and heel height.
13. For leg specifications, indicate if it is left, right, or bilateral, followed by weight.
14. Choose the material type and the specific orthosis type from the provided options.
15. Select appropriate thermoplastic or metal and leather options based on the patient's needs.
16. Indicate preferences for ankle joints, stirrups, and additional components based on the specifications required for the orthosis.
17. Ensure all additional instructions, notes, and customization requests are clearly outlined.
18. Once completed, save changes, download, print, or share the form as needed.

Complete your Becker AFO Orthometry Form online today for a smooth and effective orthotic fabrication process.