Clyde's Face Masks / Call Clyde 800.253.6217 or Text 317.445-1475

2/21/17
PA: Morgan H./Rutherfordton, NC
RX: Mask for Broken Nose / Soccer
DX: Nasal Fracture ICD-10 Billing Code S02.2xxB
P: Fabricate Madrid mask for soccer / female / 5'6" / 140lbs / color:black
Website: www.indianabrace.com
Practitioner: Clyde Peach CO - ABC Certified Orthotist #1321
American Board for Certification in Orthotics & Prosthetics