Broken Nose Mask / Clyde's Face Masks 800.253.6217 Text 317.445.1475

3/1/17
PA: Betty H. (son) / Daniels, WV
RX: Protective Mask for Broken Noses
DX: Multiple Fractures of Nasal Bones
ICD-10-CM Diagnosis Code: S02 2XXA
HX: Athlete has sustained multiple nasal fractures over the years.
Plan:
Custom-fabricate Hoosier mask (color: black) using shatter proof low
density polyethalene that will not re-injure recent fractures, will
shape to face naturally and avoid eye injuries. Customize design for
maximum nasal protection and minimum obstruction of peripheral and
downward vision. Add gentle bumper contact pads internally.
Sport: Basketball
Website: www.indianabrace.com
Practitioner: Clyde Peach, CO - ABC Certified Orthotist #1321 - 1979
American Board for Certification in Orthotics & Prosthetics