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Home > Medical Center > Forms > Clinical Care Forms and Consents > Clinical Forms > University Health > PROSTHETICS AND ORTHOTICS ATTESTATION-DIABETIC SHOES AND INSERTS

form 240401 : PROSTHETICS AND ORTHOTICS ATTESTATION-DIABETIC SHOES AND INSERTS

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view  |  PDF document icon 240401 P&O Attestation Diabetic Shoes and Inserts.pdf — PDF document, 76 KB (78632 bytes)


  1. effective date:

    April 2024

version information:

document number:   240401
document owner:   Jeanette Baber
effective date:   April 2024
Clinical Form Request

To request a new revision of a Clinical form visit the HIS website.

 

To order multiple copies:

 

  1. Search for and choose the appropriate document. 
  2. Right click the document PDF
  3. Select “Copy shortcut”
  4. Send an email with the PDF form attached to hospcopy@virginia.edu and include the following information:
    • Your name
    • PTAO
    • Quantity
    • Contact/Delivery information

 

PLEASE INCLUDE SPECIFIC PRINTING INSTRUCTIONS (i.e. multi part form, NCR, etc...) 

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