Orbit Fracture Face Mask to Champaign, IL

Rx: 1/12/16 protective face mask  for right orbit fracture / Champaign, IL

Diagnosis:fractures of: 1. fracture right inferior orbital rim and floor of right orbit. 2. fracture lateral orbital wall. 3. fracture right maxillary sinus: anterior and lateral walls. no nasal fractures. ICD-10-SM S02.3XXA

Plan: Fabricate Gladiator model basketball orbit fracture face mask. Use clear DuPont Surlyn with black straps.

Sx: Order received 1/12/ 16 1:02 AM via  website www.indianabrace.com. Shipped UPS Ground 01/12/ 16 to T.K. In Champaign, IL . Expect delivery in 1 day

FU: Schedule email to customer satisfaction questionnaire on 1/22/16

Clyde Peach, CO
www.indianbrace.com