Orthema Orthotic Prescription Form V2014.09.04 2026

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  1. Click ‘Get Form’ to open the Orthema Orthotic Prescription Form V2014.09.04 in the editor.
  2. Begin by filling out the 'Patient Details' section, including title, name, practitioner, location, and payment method.
  3. Enter the patient's date of birth, height, weight, CCSS region, diagnosis, today's date, and required date.
  4. Select the 3D capture method from options like Foam Impression Box or Plaster Cast.
  5. Complete the 'Pre-Metatarsal Supports' section by indicating sizes for left (L) and right (R) feet as needed.
  6. Fill in 'Milling Specifications' with shoe size and block type preferences while specifying arch support percentages.
  7. Add any special modifications or comments in the designated areas to ensure precise customization.

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Prescription foot orthotics are custom-made shoe inserts designed for the individual wearer. They are medical devices designed to correct biomechanical imbalances, allowing for normal function and alignment of the foot.
Orthotics Insurance Coverage Requirements The following are usually necessary to get your orthotics covered by insurance: A diagnosis from a podiatrist or foot care specialist. A prescription for a custom orthotic from a qualified professional. A description of the raw materials used to make the orthotics
Your foot and ankle specialist (podiatrist) may recommend you try an over-the-counter orthotic device if you have mild symptoms related to your condition. If symptoms persist or worsen, they may prescribe a more advanced option, like custom orthotics.

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Orthotic prescriptions provide support to the foot, ankle, and leg. They are commonly used to treat conditions such as plantar fasciitis, Achilles tendinitis, and runners knee. Orthotics can be custom-made or purchased over-the-counter.