Patient Care Protocol

At ASAProsthetics we want to make your experience a positive one. If you have a patient that needs prosthetic or orthotic care, please see the patient care protocol below.

Send a Referral/Script

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  • Prosthetic Care Protocol
  • Orthotic Care Protocol
1. Refer your patient:

A prosthetic referral can be written in nearly any format and media, such as: piece of paper, facility script pad, ASAProsthetics script pad, ASAProsthetics referral form, “send a script” located on this website. Based on insurance/Medicare requirements, the referral must include the following information:

  • Patient Name
  • Date of Birth (DOB)
  • Location of Amputation, Right (Rt), Left (Lt), Bilateral (Bi-lat)
  • Level of Amputation
  • Order to “Evaluate for Prosthesis”
  • Licensed Physician Signature
  • Send signed referral to:
    • Fax to 832.813.8702
    • Email to admin@asaprosthetics.com
    • Call us at 832.813.5278 if you want us to come in and pick up referral
    • Give to patient to bring to our office
  • Provide patient demographics/face sheet along with recent clinical notes – this additional information will help us better evaluate and treat your patient.
2. Review & Sign Detailed Prescription:

After ASAProsthetics has evaluated your patient for his/her prosthetic care needs, we will send the following for you to review and approve:

  • Detailed prescription, which will include all L-Codes and descriptions for prosthetic services needed by your patient
  • Patient evaluation and justification for prosthetic services
  • Make any suggestions/recommended changes
  • Send signed detailed prescription to:
    • Fax to 832.813.8702
    • Email to admin@asaprosthetics.com
    • Call us at 832.813.5278 to come in and pick up signed detailed prescription
    • Give to patient to bring to our office.
3. Communicate with us:

At this point, all paperwork has been signed and completed for the prosthetic care needed by your patient. If at any time, you or your patient has concerns about the fit or function of his/her prosthesis, please contact us by phone at: 832.813.5278.

We want this entire process to be as smooth and efficient as possible. If you have any questions, concerns, or suggestions on how we can better serve you, please let us know. We are firm believers in the adage that if you like how we treat you, please tell others, and if there are ways we can treat you better, please tell us.

1. Refer your patient:

An orthotic referral can be written written in nearly any format and media, such as: piece of paper, facility script pad, ASAProsthetics script pad, ASAProsthetics referral form, “send a script” located on this website. Based on insurance/Medicare requirements, the referral must have the following information:

  • Patient Name
  • Date of Birth (DOB)
  • Order to “Evaluate for Bracing/Orthoses”
  • Identification of extremity or region of the body needing evaluation (i.e. left lower extremity, or spinal, etc)
  • Patient Diagnosis Code
  • Licensed Physician Signature
  • Clinical notes supporting your referral
  • Some orthotic services/diagnoses require additional information. Once we have received your referral, we will notify you if additional information is required.
  • Send signed referral to:
    • Fax to 832.813.8702
    • Email to admin@asaprosthetics.com
    • Call us at 832.813.5278 if you want us to come in and pick up referral
    • Give to patient to bring to our office
2. Review & Sign Detailed Prescription:

After ASAProsthetics – Orthotics Division has evaluated your patient for his/her orthotic care needs, we will send the following for you to review and approve:

  • Detailed prescription, which will include all L-Codes/A-Codes and descriptions for orthotic services needed by your patient
  • Make any suggestions/recommended changes
  • Send signed detailed prescription to:
    • Fax to 832.813.8702
    • Email to admin@asaprosthetics.com
    • Call us at 832.813.5278 to come in and pick up signed detailed prescription
    • Give to patient to bring to our office
3. Communicate with us:

At this point, all paperwork has been signed and completed for the orthotic care needed by your patient. If at any time, you or your patient has concerns about the fit or function of his/her orthotic device, please contact us by phone at: 832.813.5278.

We want this entire process to be as smooth and efficient as possible. If you have any questions, concerns, or suggestions on how we can better serve you, please let us know. We are firm believers in the adage that if you like how we treat you, please tell others, and if there are ways we can treat you better, please tell us.