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Effective Prescription Writing

Effective Prescription Writing

Prescription Form
Rx for Custom Foot Orthoses

Rx Overview

The following is an overview of the multiple options available on our custom foot orthotic prescription form. Clients may contact ProLab Medical Consultants or Client Services for answers to questions or recommendations.

Patient Information

Always include the patient’s weight and diagnosis. Failure to include this information may cause a delay in production. The weight helps us determine the correct thickness and rigidity of the orthoses. The diagnosis is used in cast and prescription evaluation.

Part A

Pathology Specific™ and Specialty Orthoses

Pathology Specific and Specialty Orthoses have predefined specifications. By checking one of the boxes, we will produce the device exactly as described on the reverse side of the Rx (page 2). You may override any of the predefined specifications by selecting an alternative option in Part B.

Part B

Polypropylene Shell

Select the production method (vacuum-formed (VAC) or milled), color, and rigidity/flexibility of the polypropylene shell. If you select only the shell type, we will make a semirigid device using standard specifications for heel cup depth, orthotic width, and cast fill. If you choose only shell rigidity or thickness, we will make a vacuum-formed, black, polypropylene device.

Shell Rigidity / Flexibility

Choose either the polypropylene thickness or shell rigidity. If you choose shell rigidity, you must include the patient weight.

Plantar View

Mark the location of all accommodations on the plantar view diagram and on the casts.

Rearfoot Post

Choose the type, motion, and material of rearfoot post. EVA is the only rearfoot post material available for graphite shells. All rearfoot posts are beveled, unless otherwise indicated, for easier shoe fit.


Choose the length, material, and gluing option for topcovers. The default is glue all, unless otherwise indicated.

Forefoot Extensions

If you select a forefoot extension, you must also select a topcover. Choose the length, material, thickness, and type of extension.

Special Additions

These additions will be applied bilaterally unless you indicate R (right) or L (left). Shoes must be sent to the lab if you are requesting toe filler.

Special Instructions

Indicate if the prescription is for an Adjustment or Refurbishment and/or any additional prescription information.

  • Order Processing: If you would like the order expedited, indicate either a 1-day rush or 3-day rush. Rush orders have an additional charge and they are shipped overnight unless otherwise specified.
  • Special Shipping: Indicate the shipping method for any order requiring special handling: FedEx Overnight, FedEx Ground, Ship to Patient.
  • Reorders: There are two ways to reorder orthoses depending if the original device was made from a CAD/CAM image or from plaster molds.
  • Image Number: Most orthoses are made from a CAD/CAM image. When you receive new orthoses, the image number is printed on the label on the bottom of the orthoses. Record this number in the patient’s chart so you will have it for future reorders. To reorder, write the image number in the Reorder box, complete the prescription form, and fax or email to ProLab.
  • Plaster molds: If the original order was made from plaster molds, you must either return the molds with the reorder prescription or send new casts.

Learn More

View our Prescription Writing Workshop video, click here.

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