WebAccording to the original 1993 TSB, the “Statement of Certifying Physician for Therapeutic Shoes” must contain the following: One or more of the indications required in table 1 are present The patient is being treated under a comprehensive plan for diabetes management The patient requires diabetic shoes, inserts, or shoes with modifications Web2. Statement of Certifying Physician • Within 3 months of delivery of shoes and inserts and Inserts 3. Diabetic Foot Exam • If not completed by MD/DO, MD/DO must sign-off and indicate agreement by other • Within 6 months of delivery 4. Prescription for Therapeutic Shoes • Detailed Written Order 5. Proof of Delivery/Warranty/Break In

Statement of Certifying Physician for Therapeutic Shoes

Webfollowing statements are true: 1. I have documented in the patient’s medical records that the patient has diabetes mellitus . 2. This patient has one or more of the following … WebJul 20, 2024 · signing the certification statement; or. Obtain, initial, date (prior to signing the certification statement), and indicate agreement with the information from the medical records of an in-person visit with a podiatrist, other M.D or D.O, PA, NP, or CNS that is within six months prior to delivery of the shoes/inserts, and that ishan sahgal grob aerospace

Clinicians! Are You Ordering Diabetic Shoes for Your Patients ...

WebThe Statement of Certifying Physician must be signed and dated within three months (90 days) prior to the delivery of diabetic shoes and shoe inserts. Which date will count for … Webthe Statement of Certifying Physician. If using your own Diabetic Foot Exam chart note, add the agreement statement on the “Certifying Physician/Practitioner Acknowledgement” before faxing to the MD/DO/NP. 4. Prescription for Therapeutic Shoes and Inserts (Detailed Written Order): Signed and dated by DPM. Can be included WebCertification Statement CDEs . TSPD: Therapeutic Shoes for Persons with Diabetes . Note: The M.D. or D.O. must attest to all of the following: In addition, statement must include the following: TSPDREAS1: The patient has diabetes mellitus . TSPDREAS2: This patient has one or more of the following conditions: (Multiple selection from safb air show 2019 wichita falls tx