Medical grade footwear (MGF) prescription form
Form ID
D0688
Audience
For providers
Orthotist
Podiatrist/Footwear prescriber
This form is used to prescribe Medical Grade Footwear. May be referred to as D0688 or D688.
If you are using an Apple computer and want to fill out your form electronically, please download the form and open it with Acrobat 7 or later.
How can I access this form?
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Form (PDF or Word)