WebCUSTOM DIABETIC INSERT ACCOMMODATIONS / L5000 ORDER FORM . Contact Name: Fax: PO Number Phone: (Please Print) Patient Name: _____ Male Female. Shoe Size Needed: _____ Accommodations: Toll Free: 1-800-998-4199 Fax: 1-800-997-9980 E-mail: [email protected] 1-6-12JH Web1. This patient has diabetes mellitus. 2. This patient has one or more of the following conditions. (Circle all that apply): a) History of partial or complete amputation of the foot b) History of previous foot ulceration c) History of pre-ulcerative callus d) Peripheral neuropathy with evidence of callus formation e) Foot deformity f) Poor ...
Therapeutic Shoes for Persons with Diabetes CMS
WebGeneral foot fatigue, arthritis, diabetes, moderate forefoot varus or valgus, plantar fasciitis, forefoot lesions, fat pad atrophy, amputees. Design Specifications: Material: Flexible polypropylene shell with low durometer EVA arch reinforcement. Heel Seat: 15mm. Posting: Intrinsic forefoot and extrinsic rearfoot posts are standard. WebPlease fax completed forms to your patient's Hanger Clinic. ... Diabetic Shoe Paperwork Author: awire Created Date: 3/25/2024 7:28:49 AM ... north carolina snow accumulation
Men’s Shoes – Stride Lite
WebJun 3, 2024 · Have a space of ½ between your longest toe and the tip of the shoe. Look for shoes that do not have inner seam as they can cause blisters or hot spots due to … WebMen’s Shoes. Boots; Classic; Flex; Sport; Men’s Shoes Quick Reference; Women’s Shoes. Classic; Flex; ... DIABETIC SOCKS. Stride Lite Diabetic Socks contain AlphaSan®, an antimicrobial additive, that utilizes the natural power of silver, resisting biological odor and staining for the life of the garment. ... Email: [email protected] ... WebStatement of Certifying Physician form. a. Must certify that patient has diabetes b. Must show diabetic management for patient’s diabetes within the last 6 months. Please note: office visit must be on or before the date on the certifying physician form c. Must document secondary diagnosis as indicated in the Statement of Certifying Physician ... how to reset desktop color