Thank you for choosing Palmetto Orthotics and Prosthetics!
We look forward to caring for you. Your insurance provider requires that we collect specific documentation from you and your doctor to support medical necessity for therapeutic shoes and inserts.
Prior to scheduling your appointment, please obtain these three supporting documents:
- A Statement of Certifying Physician for Therapeutic Shoes (see link)
- This document certifies your need for therapeutic shoes.
- This must be completed and signed by the physician who is treating your diabetes.
This physician must be an MD or DO.
- A Standard Written Order (see link)
- This document specifies the item(s) that the ordering provider is requesting be provided to you.
- The ordering provider can be your doctor, podiatrist, nurse practitioner, physician assistant or clinical nurse specialist.
- Clinical Evaluation/Notes (Acquire directly from your doctor)
- Your doctor can print and provide to you or fax to our office.
- Notes must document that the physician is treating your diabetes and must be from the same physician that completes the Statement of Certifying Physician noted above.
- Notes must indicate medical necessity for therapeutic shoes in the treatment of your diabetes.
- The evaluation must be within 6 months prior to receiving your shoes and/or inserts.
If you have not seen your diabetic physician within the last 6 months, you will be required to schedule an appointment to have the examination completed. Your doctor may fax the required documentation directly to Palmetto Orthotic and Prosthetic Center or you may bring it in. Once we receive these documents, we will review them and call you to schedule your evaluation/fitting appointment.
