Use the form provided to generate a Insurance-compliant diabetic foot exam note.
This documentation is intended for primary care providers and ensures the patient qualifies for therapeutic diabetic shoes.
Once completed, copy and paste the note directly into the patient’s chart under the Plan section to meet insurance requirements.
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
