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Get and Sign Home Address City State Zip  Form

Get and Sign Home Address City State Zip Form

Use a Home Address City State Zip 0 template to make your document workflow more streamlined.

Conditions Orthostatic hypotension Low blood pressure upon sitting or standing Vertigo Other balance-related disorder Please list Medical Equipment Do you own rent or use any medical equipment For mobility/walking Examples wheelchair rollator walker cane For any of your activities of daily living Examples elevated toilet seat bedside commode reacher Do you use an orthotic or prosthetic device YES Examples ankle-foot orthosis prosthetic limb If yes please list MRC Dyspnea Scale Please circle the...
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