Designed for physicians prescribing assistive devices, this form supports access to orthoses, prostheses, orthopaedic devices, mobility aids, postural supports, and other medically necessary equipment for individuals with physical disabilities. It captures patient identification, diagnosis, functional impairment, duration of medical necessity and detailed prescription instructions. The form also documents daily wear requirements, treatment duration, and specific clinical information for children when applicable. Heidi helps clinicians efficiently generate structured prescriptions that support accurate documentation, facilitate timely access to assistive devices, and streamline administrative processes for patients requiring rehabilitation and mobility support.
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