This form is for physicians or healthcare providers to attest that a comprehensive foot exam has been performed by another qualified provider. By completing this attestation, you are confirming that you have reviewed the exam results and acknowledge the findings for the patient’s medical record.
Provide Certification of Medical Necessity & Prescription
Please complete the combined Certification of Medical Necessity & Prescription form.
The CMN, prescription, and recent medical notes are required to confirm medical need and meet Medicare/insurance rules. Without them, we cannot provide diabetic shoes or related services.
You may either download it and return it to us via fax or email, or simply fill it out online using this link: intake.diabeticshoeclinic.com/cmn
