Physician Files

These are forms and Use & Care documents that may prove beneficial to our Physician friends. All are in PDF format which requires a Portable Document Reader application (Such as Adobe Reader which is free to download and use).

Orthotics & Prosthetics of Pinehurst ::: general forms :::

Patient Sign-in Form – Download

Patient Consent Form for Photos Download

Lower Extremity Prosthetic Prescription – 

Revised (Aug 2017) Face to Face and written order requirements for certain types of DME – 

CMS Dear Physician Letter (To be retired) –

Diabetic & Therapeutic Shoe Statement and Certification –  

Mastectomy

Post Mastectomy Supply – Use & Care Download

Breast Prosthesis – Use & Care Download

Orthotics

Post Op Shoe/Walking Boot – Use & Care – Download

LSO/TLSO – Use & Care – Download

Knee Brace – Use & Care – Download

Knee Ankle Foot Orthosis – Use & Care – Download

Cervical Collar – Use & Care – Download

Ankle Foot Orthosis – Use & Care – Download

Pedorthics

Diabetic Shoes & Inserts – Use & Care – Download

Prosthetics

Lower Limb – Use & Care – Download