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Assessment Form - Comfy Splints

Assessment Form - Comfy Splints 2025

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The document provides detailed instructions and a care plan for the Comfy™ Grip Hand Orthosis, designed to support and position hands affected by various conditions such as wrist drop, arthritis, and neuromuscular impairments. It outlines fitting procedures, indications, contraindications, maintenance guidelines, and assessment forms for healthcare professionals to ensure proper use and monitoring of the orthosis.

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Click ‘Get Form’ to open the Assessment Form - Comfy Splints in the editor.
Begin by entering the patient’s name and HICN # at the top of the form. Ensure accuracy for proper identification.
Fill in the facility details, including address, and primary diagnosis. If applicable, add a secondary diagnosis for comprehensive assessment.
Indicate prognosis by selecting 'Good', 'Fair', or 'Poor' from the options provided.
Complete mobility status by checking either 'Ambulatory', 'Wheelchair Confined', or 'Bed Confined'.
Assess communication abilities and U.E. sensation by selecting appropriate options from the dropdowns.
Document U.E. Active and Passive ROM status as either 'WNL', 'Mildly Restricted', or 'Severely Restricted'.
List treatment goals based on specific conditions such as wrist drop or joint pain, ensuring all relevant goals are included.
Finally, have the O.T./P.T. sign and date the form, providing their contact information for verification.

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Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

How to correctly apply a splint?

Try to include the joint above and below the injury in the splint. The added support and stability can help decrease pain. Secure the splint with ties, such as belts, cloth strips, neckties, or tape above and below the injury. Make sure the knots are not pressing on the injury.

How should splints be positioned?

The lower end of the splint should be elevated to avoid further swelling. For example, a sling on the upper extremity should be position so that the hand is above the level of the elbow. For lower extremity splints the foot should be elevated on a chair if sitting or a pillow if lying.

What is the L code for comfy splint?

Reimbursement PDAC/HCPCS code: L3807 or L3809 Our popular ComfySplints Hand Wrist Orthosis provides support and positioning for the weak or deformed Wrist, Hand or Fingers. This is the ideal positioning splint or use for gradual extension of non-fixed wrist/ hand.

What is the safe position for hand splint?

The intrinsic plus (or Edinburgh) position has otherwise been known as the safe position for hand splinting. The hand can be immobilized in this position for long periods of time without developing as much stiffness as would occur if the digits were positioned differently.

What are 3 things you should not do while splinting?

Splint and skin care If your splint is not to be removed, try blowing cool air from a hair dryer or fan into the splint to help relieve itching. Never stick items under your splint to scratch the skin. Do not use oils or lotions near your splint.