Broken Nose Mask / Madrid Model Soccer to Brent D. / Winnetka, IL STAT

Website Order Taken : 3/20/17 @ 7:56 PM Shipped: 3/21/17 @ 5:00 PM UPS Next Day Air
PA: Brent D's  (daughter) /Winnetka, IL
RX: Protective Mask for Broken Nose
DX: Fractures of Nasal Bones
ICD-10-CM Diagnosis Code: S02 2XXA
HX: Athlete has sustained nasal fracture during soccer.
Plan: Custom-fabricate Madrid model (color: clear) using shatter proof DuPont Surlyn 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 moleskin contact bumper pads internally for comfort.
Sport: soccer
Website: www.indianabrace.com
Practitioner: Clyde Peach, CO - ABC Certified Orthotist #1321 - 1979
Contact: Call: 800.253.6217 Text: 317.445.1475 Email: clyde.peach@gmail.com
American Board for Certification in Orthotics & Prosthetics