Diabetic shoes PDF - Prescription for Therapeutic Footwear 2025

1. Click ‘Get Form’ to open the diabetic shoes PDF in the editor.
2. Begin by entering the patient’s name and date of birth in the designated fields. Ensure accuracy as this information is crucial for identification.
3. In the certification section, check all applicable boxes regarding the patient's diabetes status and any related conditions. Be sure to include the appropriate ICD-10 codes where required.
4. Indicate whether a recent foot exam has been performed within the last six months and document any qualifying conditions that have been noted.
5. Specify the type and quantity of diabetic footwear or inserts needed by checking the relevant options. Ensure that a physician's signature is included at the bottom of the form.
6. Finally, review all entries for completeness and accuracy before saving or exporting your completed form for submission.

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