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Break-In
instructions for new shoes.
Congratulations on receiving your new shoes. In accordance with Medicare
regulations, they have been selected from our own inventory, from another
company or have been fabricated to provide you with optimum comfort and
protection. In order to receive the greatest benefits from this footwear,
please follow these suggested guidelines.
Getting used to your shoes
People with decreased feeling in their feet may have a false sense of security
as to how much at risk their feet actually are. An ulcer under the foot can
develop in a couple of hours even if the shoes are expertly fit. In order to
best avoid any irritation, please adhere to the following break-in schedule:
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FIRST DAY |
Wear One Hour |
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SECOND DAY |
Wear Two Hours – Check feet after first hour |
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THIRD DAY |
Wear Three Hours |
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FOURTH DAY |
Wear Four Hours – Check feet after two hours |
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FIFTH DAY |
Wear Full Day – Check after lunch |
- IF AT ANY TIME YOU
SEE RED SPOTS OR DARKNESS ON THE TOES OR OTHER BONY AREAS DURING THE FIRST
FIVE DAYS: Discontinue wearing the shoes for the rest of the day and start
routine again the next day beginning with one hour of wear.
- IF A RED SPOT OR
DARKNESS APPEARS WITH EVERY WEARING – PLEASE DO NOT WEAR SHOES. Call
____________________ at (_____)________________ for an adjustment appointment.
(name of
practice)
- BE SURE TO INSPECT
YOUR FEET EVERY DAY.
Follow-Up
You should have regularly scheduled visits with ________________. Please
direct any questions about the items received today to this office. Billing
questions may be directed to your Medicare carrier. Every four months get rid
of the inserts in your shoes and put in a new pair. In one year, you will
receive a reminder to return to __________________ to evaluate the condition of these
shoes.
Return Policy
Shoes that are unsuitable may be returned within four weeks of dispensing. The
shoes must be in good condition, i.e., no scuffmarks, outside dirt or obvious
wear on the soles. We strongly urge you to wear these shoes in your home for
the first week. Substandard shoes may also be returned as all warranties,
expressed and implied under applicable State law will be honored.
I certify that I have received the item(s) marked below in good condition. The
Practitioner has explained, in detail, the proper use and care of this device
and has fit it to me. The Practitioner has asked me to call the office if I
encounter any problems with the device or if I have any questions. I have been
informed of the Medicare DMEPOS Supplier Standards.
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Name:_____________
Signature:_______________________ |
Date___________ |
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Qty:____ Manufacturer:____________ Description:____________________ |
Size:_____Width:_____ |
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Qty:____ Manufacturer:____________ Description:____________________ |
Size:_____Width:_____ |
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Original: To Patient Copy: To Patient File Faxed Date:______________________
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