Durretts Orthotic and Prosthetic Resource Center in Edgewood, Kentucky

Forms and Pamphlets

  • Key:
  • Word
  • PDF
  • Excel
  • PowerPoint
Patient Information Description
Patient Information Form Durrett's Orthotic and Prosthetic Services Patient Information Form
Acknowledgement of Receipt of Notice of Privacy Practices Acknowledge Receipt of Privacy Practice
HIPAA Notice of Privacy Practices
Medicare Supplier Standards Supplier Standards for Medicare Patients
Shoe Statement Physician Statement for Diabetic Shoes
Patient Evaluation for Spinal Orthosis Patient evaluation form to be completed if you are receiving a spinal orthosis.
Patient Evaluation for Prosthetics Patient evaluation form to be completed if you are receiving a Prosthesis.
Patient Evaluation for Lower Extremity Orthotics Patient evaluation form to be completed if you are receiving a lower extremity orthotic

Top