LE Orthotic Form

LE Orthotic Form

Joan K. Cestaro, CP

2/18/2003

I realize that forms in this field have some secret access code, are
patented or are forbidden for release, but I'm attempting a plea
regardless!

I'm trying to fabricate a lower extremity orthotic evaluation form
(geared toward AFO/KAFO) that will also include medical justification
for the additional componentry used. I would be very appreciative if
anyone would share forms currently in use that include either an
evaluation form (muscle evaluation, gait deviations, degrees of
varus/valgus at knee or ankle, etc) and/or justifications for components
(joints, T-strap, split calipers).

To be in compliance, medical justification must be stated for each
billable componentry addition. This is pretty simple, for example, on
df assist ankle joints- (support weak dorsiflexors or, simply, drop
foot). A T-strap is also pretty easy to justify, but what about split
caliper? Except for diabetics who are advised to change shoes at least
once per day to relieve pressures, I am finding a MEDICAL justification
for the addition of a split stirrup almost impossible! I think a form
with some sort of check off box would assist all of our Practitioners
and make things so much easier. It's more efficient than dictating
which I am finding is not being well done.

I hereby promise to keep any and all information or forms received
totally confidential. My secret access code: PLEASE


Joan K. Cestaro, C.P.
RPI- Virginia
HOME FAX: 1-540-723-8775
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