Thank you for inquiring about Advanced Prosthetics & Orthotics of America patient care program.

Our Mission
We offer a comprehensive prosthetic care program developed by Advanced Prosthetics & Orthotics of America to address the need for a program specially designed for the complete rehabilitation of the amputee.

Our Program
Currently amputees as a whole are an under-served group with many special needs. We feel our services would be of great benefit to your patients. Our dedicated staff of over 45 professionals, service the state using our multiple offices and specially designed mobile prosthetic units. Advanced Prosthetics cares for patients utilizing a very unique program of services that are very beneficial to amputees at no additional cost to the patients, attending facility or the insurance payer.

Just one service our patients greatly appreciate is our fully equipped mobile prosthetic units that provide complete care at the healthcare facility and the patient’s home upon discharge. For many amputees, multiple trips to a prosthetic facility to be fitted properly with an artificial limb are difficult if not impossible. The very nature of their disability, general health conditions and sometimes age limits mobility. This is especially true of the patients who do not have accessible or reliable transportation, who do not live close to a prosthetic facility or are residents of a healthcare/assisted living facility. Our patients are followed up on an individual and continual basis by a case manager to help ensure their satisfaction and the success with a prosthetic device. The normal protocol that many amputees experience is that the prescription is filled for a prosthesis by a provider and the patient is never followed up on to help insure their success and complete rehabilitation with a prosthesis. Unfortunately, many times the patient just gives up using the prosthesis due to one or more of the following:

• Transportation problems (Elderly and Indigent Patients)
• Turnaround time & inconvenience (Many visits to a O&P facility to get properly fit)
• Unaddressed skin or tissue irritation (Swelling, blisters, ulcers, further complications)
• Inappropriate component selection (Prosthesis too heavy/activity level not accommodated)
• Needed prosthesis adjustments (Changes due to weight gain or loss/Proper gait alignments)
• Safety concerns (Not a secure fit/fear of falling down)
• Supply access (No replacement for worn socks, sheaths & suspension liners)
• Repairs (Broken parts)
• Proper use (Putting on & proper cleaning to insure proper functioning)
• Environmental Problem (Can’t use prosthesis to go up stairs at home)
• Physical therapy training (Never taught to improve the range of movement & strength)

All these issues are very important to ensure that amputees are successful with prosthetics. We make prosthetics a positive experience for the patient versus a hassle that results in them not wearing the device that can improve their quality of life.

The Results
Appropriate, consistent, convenient and encouraging patient follow-up will result in a tremendous increase in patient compliance and prosthetic success resulting in the improvement of the patient’s standard of life that rehabilitation was designed to accomplish. We have many other services that we provide to our patients. Enclosed are further details on these services. No other prosthetic facility offers our patient care program and we know Advanced services can help many of your patients. We would be happy to arrange an In-service with you and/or with your staff to review our entire program. All your patients who are amputees can greatly benefit!

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Advanced is improving the way prosthetic patients are serviced throughout the state and at the same time enhancing the quality of life for patients.

I. How many times are you requiring your patients to get transportation to a fixed facility for prosthetics?
Patients can require up to 14 visits or more to a fixed facility in just the first 3 to 6 months of
prosthetic service after amputation, for proper care and follow-up.

II. The future of convenient quality prosthetic care has already begun at Advanced.
At Advanced, with our unique program, we are removing the barriers and difficulties transportation to a fixed facility
creates for prosthetic service for many patients throughout the state. The traditional process of requiring patients to
make multiple trips to a prosthetic facility for care and follow-up has been replaced by a new process designed by
Advanced to give patients convenient service and follow-up in their home / healthcare facility. It is about a new
approach to proactive prosthetic care that gives a patient a better opportunity to be successful by making the
process of receiving prosthetic care more convenient. Patients don’t need to visit and return to a fixed facility
multiple times to get a prosthesis, or wait weeks to get their prosthesis repaired or adjusted. These services are
provided on site at the patient’s home / healthcare facility. While visiting the patient, we evaluate the patient’s home
/ facility environment (their daily lifestyle – Do they need to go up and down steps, & how many…?) in helping
determine appropriate prosthetic design. Our prosthetists provide quality, one-on-one time with the patient in the
comfort and privacy of their own home. Again, we make life easier for the patient.

III. Advanced Prosthetic Care Formula
Easier accessibility to prosthetic care = better compliance + rehabilitation outcomes.

IV. Advanced is making life easier for the patient by bringing quality prosthetic care and
follow-up to the patient in the convenience and comfort of their own home statewide.
Imagine missing one and possibly both limbs and having to make multiple trips back and forth to a prosthetic facility
for prosthetic service and follow-up. So many amputees give up wearing prosthetics or wear ill-fitting prosthetics
causing other physical / medical complications because of the difficulty of the process itself of arranging convenient
transportation to and from their home to get prosthetic service. Amputation is a life long event that is a challenge
itself without adding the barriers of transportation difficulties / complications to get prosthetic service. After hearing
numerous complaints from patients of the difficulty of making the many required visits to get proper prosthetic care
and follow-up, we developed our unique mobile prosthetic service. Advanced in-home prosthetic program was
developed with the valuable input of numerous physicians / other healthcare providers and the patients themselves.

V. Overcoming the Amputation: The importance of early patient intervention by Advanced.
Positive outcomes are best achieved by the Surgeons getting the patient together with the prosthetic provider as soon
as possible just before or after surgery. The Surgeon or the Surgeon’s staff can follow this easy referral process:
(a) Tell your patient the last consult before the surgery, Advanced will be contacting them concerning prosthetic care
and give them appropriate information. (b) Call Advanced at 1-800-330-8881 or use our fast fax referral form to send
patient’s information to the corporate office at: 1-800-261-9537. Advanced patient case managers will be following
up with the patient to insure the patient receives quality service and follow-up care. (c) Advanced will contact the
patient and get all required insurance approvals. (Advanced works with the primary care physicians as needed for
prosthetic approvals). (d) Advanced patient care representative will visit the patient and get all required patient
documentation, explain the process of being fit with a prosthesis, put the patient at ease, and leave helpful
information. (e) A convenient appointment will be made for our prosthetist to visit and evaluate the patient in the
patient’s home / healthcare facility. (f) In conjunction with our prosthetist training the patient to use their new
prosthesis, in-home physical therapy can be arranged through our association with many quality providers or with the
physician’s provider of choice.

VI. The long challenge of getting proper prosthetic service and follow-up.
Patients can require up to 14 visits or more to a prosthetic facility in just the first 3 – 6 months of prosthetic service
after the amputation. Advanced does all the following visits in the comfort, convenience, and privacy of the patient’s
home.

• Visit #1: Evaluation / Shrinker Fitting
• Visit #2: Casting
• Visit #3: Test Socket #1
• Visit #4: Test Socket #2 (two or more test sockets possible depending on level of amputation and / or physical changes)
• Visit #5: Prosthesis Delivery
• Visit #6: Prosthetic follow-up after prosthesis fitting
• Visit #7: Continued prosthetic follow- up after prosthetic fitting
• Visit #8: Physical Changes in patient’s limb (increase or decrease in limb volume) necessitate patient to be recast for new socket.
• Visit #9: Test Socket #1
• Visit #10: Test Socket #2 (two or more test sockets possible depending on level of amputation and / or physical changes)
• Visit #11: Prosthesis Delivery
• Visit #12: Prosthetic follow-up after prosthesis fitting
• Visit #13: Continued prosthetic follow-up after prosthetic fitting
• Visit #14: Six month prosthetic follow-up
• Visit #15+: Continual visits are required depending upon the patient’s activity level (more active patients put more wear and tear on their prosthesis), additional amputations (these may require refitting of the prosthetics on both limbs), revision surgeries (these will require the remaking of the prosthetic socket at a minimum), follow-up adjustments / changes in componentry (these changes should be evaluated on a continual basis), and replacement of patient’s supplies (good hygiene promotes less medical complications)

VII.Changing the rehabilitation success by helping patients to achieve favorable results
It has been our experience that patients sometimes get lost after amputation. Patients are discharged from the
hospitals (sometimes in just 4 or 5 days after amputation) or the long / short term healthcare facility with little or no
knowledge of how to be proactive in returning to as normal life as possible. Some patients just continue to sit in their
wheelchair for many months after amputation without prosthetic care. Patients need to learn about prosthetics either
before or right after the amputation to psychologically prepare themselves that they can return to the everyday
Activities of Daily Living (ADL). Patients need to look forward to the future, not back at the past. Patients need more
education on their prosthetic options so they can be more proactive in their own prosthetic care. Advanced program
of early prosthetic intervention and convenient care / follow-up will produce the long term rehabilitation opportunities
you desire for your patients. We will make sure your patients appreciate you for referring them to Advanced.

Visit us on our website at Advancedpando.com or on the homepage of the following:

• Florida Vascular Society
• Florida Orthopaedic Society
• Through many of the links to us from other professional societies/groups & associations.
  Please visit our home page for more links!

1. The patient doesn’t have to coordinate or pay for transportation to and from a facility.
2. The patient does not expend limited physical energy traveling to a facility.
3. Visits can be scheduled at the patient’s convenience.
4. As a guest in the patient’s home, the practitioner can observe and learn a great deal about the patient’s environment.
5. Working in conjunction with a Home Physical Therapist, the patient can be trained to use his device in the environment where he will use it most.
6. The patient is likely to be more comfortable and less anxious in their own home.
7. There is never a charge for In-Home service or evaluations.
8. Patients never spend time waiting in an office waiting room. If there is a delay in the practitioner’s arrival, the patient is waiting in the comfort of their own home.
9. A patient is never made to feel rushed because of others waiting behind him.
10. It is easier to develop a relationship with someone in their home rather than a clinic.

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• In-Home or In-Facility Prosthetic Services: A dedicated staff of professionals that service the state using specially designed & equipped mobile prosthetic units along with multiple office locations.
• Pre/Post Surgical Consultation: With one of our many representatives, who are amputees themselves.
• Hassle-Free Referral Process Which Includes:
  • Rapid fax referral form or easy call in to Advanced Prosthetics & Orthotics of America^tm.
  • Insurance verification by our insurance department.
  • Appointment scheduled with patient within 24 hours of receipt of referral by our patient care department
  • Evaluation-casting-supply prescription obtained from the physician by our referral department
• Patient Education Program:
  • Educational materials given upon initial visit:
  • Article on dealing with amputation
  • Information on phantom pain
  • Advance’s Informative Newsletter
  • Rights and responsibilities of patient
  • Proper care of residual limb
  • Amputee support group resources
  • Explanation of complete process involved in rehabilitation and prosthesis fabrication.
• Team Approach: Working with surgeons, physiatrist, occupational therapy, physical therapy, nursing and one of our licensed and certified prosthetists to ensure the optimal outcome for each patient.
• Case Management Department: Specializing in follow up of the amputee patient. This is a long term program in which all of our patients receive regularly scheduled courtesy calls and visits, to insure the patient is utilizing our services to their fullest potential. Progress reports are available to physicians and healthcare professionals upon request.
• Educational Programs: Informative presentations on an array of key topics involved with prosthetics and amputee rehabilitation. Topics included: the latest advances in prosthetic technology, the team approach to amputee rehabilitation, and the history of prosthetics (past, present, future)
• Amputee Forums: That are designed to educate the healthcare community on the different services available to the amputee and how to improve their quality of life.
• Continuing Educational Program: That provides 1 (One) contact hour for physical therapists.
  (Inquire about our other professional educational programs including those for occupational therapists & nurses.)
• Nursing home program: designed for the amputee in a skilled nursing facility.
• Prosthetic Evaluation Clinics: In-Home/In-Facility evaluation arranged to thoroughly examine prosthetic needs and rehabilitation benefits to the patient.
• Specialized In-Home Program: for the amputee that with one call provides:
  • In-Home nursing/wound care • In-Home occupational therapy
  • In-Home physical therapy • In-Home prosthetic services
  • In-Home psychiatric therapy
• Advanced provides all in-home prosthetic services. Other in-home services provided in cooperation with other quality healthcare providers.
• Amputee Support Group Organization: We will assist in forming a local support group for patients or facilities or make informative presentations to existing groups.

All of the above are services that we provide at no extra charge to our patients, referring facility or insurance carrier. At Advanced Prosthetics of America, Inc, we pride ourselves in the fact that our patients receive unique and beneficial services that go above and beyond the industry standard. Unfortunately transportation difficulties and lack of follow-up are two major problems that occur frequently in the prosthetic industry, but are two of the most important aspects to ensure that amputees are successful with prosthetics. Given a chance, you and your patients will be amazed by the level of service provided in order to improve the quality of life for amputees in the state.

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The Advanced Prosthetics & Orthotics of America^tm Amputee Clinic serves the amputee patient by providing a full range of rehabilitative services including:

• Comprehensive Medical Evaluations
• Physical Therapy
• Occupational Therapy
• Design and Fit of the Prosthesis
• Adjustments and modifications to existing Prosthesis
• Psychological evaluation & Counseling
• Social Services
• Nutritional Assessment & Counseling
• Amputee care, whether prosthesis is indicated or not
• Amputee support group information or assistance in organizing one
• Follow-up program

The focus of the Advanced Prosthetics & Orthotics of America^tm Amputee Clinic is a multi-faceted program specifically designed for the amputee patient. The program adapts itself to the circumstances relating to each individual patient.

• Pre-surgical/Post-surgical consultation by a team of specialists ranging from surgeon, physiatrist, physical therapist, occupational therapist, dieticians, prosthetist and existing amputees.
• At initial consultation each patient will receive vital information regarding the process and what to expect from their rehabilitation process in the coming months.
• Assistance in dealing with the emotional aspects of amputation.
• Information on management of residual limb pain and phantom limb pain.
• Information on management of residual limb skin problems
• Prescription of Prosthesis
• Fabrication and modification of Prosthesis
• Physical therapy and Occupational therapy training for prosthesis use.
• Long term care program that includes a regularly scheduled appointment to the clinic for follow up and evaluation of progress by THE TEAM.

The Advanced Prosthetics & Orthotics of America^tm team is involved in all facets of your treatment program. Together we will provide education, assistance in setting goals, address concerns from you and your family, and improve your quality of life.

The TEAM includes:

Surgeon
Various surgeons will be involved in the program; surgeons performing amputations may vary from Vascular Surgeons to Orthopaedic Surgeons to General Surgeons to Foot and Ankle Surgeons.

Physiatrist
Physiatrists are doctors who specialize in physical medicine and rehabilitation. The physiatrist will coordinate the treatment program with the Amputee Team to maximize your level of function.

Prosthetist
A licensed and board certified Prosthetist from Advanced Prosthetics & Orthotics of America^tm is responsible for designing and fabrication of the prescribed prosthesis. The Prosthetist also reinforces the importance of proper care of the residual limb and gives instruction for prosthetic use, care and ongoing modification as needed.

Physical Therapist
The physical therapist (PT) will work with the patient after surgery to increase strength, range of motion and endurance with exercise. They will also instruct patients on proper dressing and wrapping techniques of the involved limb, in addition to safe transfers and walking.

Occupational Therapist
The occupational therapist (OT) works to insure safe and independent use of the prosthesis. The OT may work with or assist the team in desensitization, range of motion and strengthening, and activities of daily living.

Registered Dietician
The registered dietician works with the patients on developing a selection of foods best suited to optimize their overall nutritional status. This plays a major role in wound healing. Special diets for cardiovascular, diabetic and renal can be developed.

Social Worker
The social worker assists in identifying financial resources, including disability applications.

Existing Amputee
Pre-surgical or Post-surgical consultation from a patient’s point of view that has been through the process and is functioning independently in the community.

Skilled Nursing Facility
Amputee Rehabilitation Program
The Advanced Prosthetics & Orthotics of America^tm Amputee Rehabilitation Program can provide your patients with:

• Comprehensive evaluation and management of persons with amputations.
• Design, fabrication and modification of Prosthesis.
• Work with Physical and Occupational Therapy in training for Prosthesis use.
• Assistance in dealing with the emotional aspects of amputation by one of our several amputees on staff.
• A long-term follow-up program to help ensure patient satisfaction and compliance.

Our program calls for an Amputee Rehabilitation Team of healthcare professionals which should include Social Worker, Nurse, Occupational Therapist, Physical Therapist, Physician and one of our Licensed and Certified Prosthetists.

For more information on how to improve the quality of life of your amputee patients, please call (800)330-8881.

With the consolidated Billing for Skilled Nursing Facilities-Balanced Budget Refinement Act of 1999 it is now possible to provide prosthetic services to Medicare patients in a SNF and the outside entity providing service bills separately for the services. For a copy of the details of the above BBRA, from the Autumn 2000 DMERC Medicare Advisory, please call (800)330-8881.

An Overview of Prosthetics
Past and Present
A Physical Therapy
Continuing Education Program
At the conclusion of the program the participants will be able to:

• Trace the progression of prosthetic limbs through history from their primitive beginnings to present.
• Discuss the current design theory and materials used in the manufacturing of prosthesis.
• Compare and contrast mobile services to fixed facilities.
• Describe current research and new prosthetic technologies.

Program Presented at Your Facility at Your Convenience!
To Schedule Program Call (800)330-8881

Course Number: CE1006241
Course Name: An Overview of Prosthetics Past and Present
This course is a Power Point presentation and is approved for 1 Contact Hour.
Accreditation of this course does not necessarily imply the FPTA supports the views of the presenter or the sponsors.

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Our program helps dialysis patients.
Advanced is making life easier for the dialysis patients by providing a comprehensive prosthetic care program that includes convenient transportation and routine follow-up.

The importance of good prosthetic care to dialysis patients.
There are many dialysis patients that are amputees due to the same medical complications of diabetes that causes kidney failure. Diabetes is the leading cause of End-Stage Renal Disease resulting in kidney dialysis. More than half of lower limb amputations in the United States occur among people with diabetes. Helping dialysis patients to receive convenient prosthetic care increases their opportunity to live a more active, healthy lifestyle. Inactivity among diabetic dialysis patients leads to further complications.

When amputees do not receive proper prosthetic care, their lifestyle and medical well being suffers tremendously. As you are aware, dialysis treatments are generally done three times a week, and require the patients to be transported back and forth to the facility. The frequency of chronic dialysis can create significant transportation problems for dialysis patients and their families. This is a hardship not only in getting to and from the dialysis facility, but in getting to other healthcare providers such as hospitals, laboratories, clinics, or physicians’ offices. It is important to the dialysis patients’ quality of life that every effort is made to give the patients the easiest access to the services that are needed. If such efforts are not made, the patients won’t receive the services they require, which will ultimately result in increased medical complications. Dialysis patients’ transportation difficulties, lack of energy, and time constraints make it difficult for the patients to get proper prosthetic care and follow-up.

Let us help improve the life of your patients.
Due to the inherent difficulties of getting proper prosthetic care, many dialysis patients give up wearing prosthetics, wear ill-fitting prosthetics, or have never worn prosthetics. Dialysis patients need a case management approach with their prosthetic care like they receive for their dialysis care. The continual use of prosthetics is important to maintaining as healthy a lifestyle as possible, helping to prevent further complications from diabetes.

Enclosed is information on our prosthetic programs that are available to all your patients.
Many vascular, orthopaedic, and other specialists send us their patients.

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• American Association of Kidney Patients (AAKP)
  3505 E. Frontage Road, Suite 315
  Tampa, FL 33607
  www.aakp.org
  
• American Association of Diabetes Educators (AADE)
  100 W. Monroe Street, Suite 400
  Chicago, IL 60603
  www.aadenet.org
  
• American Diabetes Association
  1701 North Beauregard Street
  Alexandria, VA 22311
  www.diabetes.org
  
• American Nephrology Nurses’ Association (ANNA)
  East Holly Avenue/Box 56
  Pitman, NJ 08071-0056
  www.annanurse.org
  
• American Society of Artificial Internal Organs (ASAIO)
  P.O. Box C
  Boca Raton, FL 33429
  www.asaio.com
  
• American Society of Hypertension (ASH)
  148 Madum Avenue, Fifth Floor
  New York, NY 10016
  www.ash-us.org
  
• American Society of Nephrology (ASN)
  1725 I Street N.W., Suite 510
  Washington, DC 20006
  www.asn-online.org
  
• American Society of Pediatric Nephrology (ASPN)
  James Whitcomb Riley Hospital for Children
  Wells Research Center, Room 2600A
  702 Barnhill Drive
  Indianapolis, IN 46202
  www.aspneph.com
  
• American Society of Transplantation (AST)
  17000 Commerce Parkway, Suite C
  Mt. Laurel, NJ 08054
  www.a-s-t.org
  
• American Society of Transplant Surgeons (ASTS)
  1020 N. Fairfax Street, Suite 200
  Alexandria, VA 22314
  www.asts.org
  
• Association for the Advancement of Medical Instrumentation (AAMI)
  1110 N. Glebe Road, Suite 220
  Arlington, VA 22201-4795
  www.aami.org
  
• Association for Organ Procurement Organizations (AOPO)
  One Cambridge Court
  1364 Beverly Road
  McLean, VA 22101
  www.aopo.org
  
• California Dialysis Council (CDC)
  1904 Naomi Place
  Prescott, AZ 86303-5061
  www.caldialysis.org
  
• European Renal Association/European Dialysis and Transplant Association (ERA/EDTA)
  Via Daniele Manin, 20
  1-35030 Bastia di Rovolon, (PD) - Italy
  www.era-edta.org
  
• European Dialysis and Transplant Nurses Association/ European Renal Care Association (EDTNA/ERCA)
  Pilatusstrasse 35
  Postfach 3052, CH-6002
  Luzern, Switzerland
  www.edtna-erca.org
  
• International Pediatric Transplant Association (IPTA)
  Progress Promozione Congressi
  Via G. Trevis, 88-00147
  Rome, Italy
  www.iptaonline.org
  
• International Society for Peritoneal Dialysis (ISPD)
  3800 Reservoir Road N.W.
  Washington, DC 20007-2196
  www.ispd.org
  
• International Society of Nephrology (ISN) c/o Emory University/Renal Division WMB
  Room 338 - 1639 Pierce Drive
  Atlanta, GA 30322
  www.isn-online.org
  
• National Kidney Foundation (NKF)
  30 East 33rd Street, Suite 1100
  New York, NY 10016
  www.kidney.org
  
• National Renal Administrators Association (NRAA)
  1904 Naomi Place
  Prescott, AZ 86303-5061
  www.nraa.org
  
• National Association for Nephrology Technicians/ Technologists (NANT)
  P.O. Box 2307
  Dayton, OH 45401-2307
  www.dialysistech.org
  
• North American Transplant Coordinators Organization (NATCO)
  P.O. Box 15384
  Lenexa, KS 66285-5384
  www.natco1.org
  
• Polycystic Kidney Disease (PKD) Foundation
  4901 Main Street, Suite 200
  Kansas City, MO 64112-2634
  www.pkdcure.org
  
• Renal Physicians Association/Renal Education Foundation (RPA/REF)
  4701 Randolph Road, Suite 102
  Rockville, MD 20852
  www.renalmd.org
  
• Renal Research Institute (RRI)
  207 East 94th Street, Suite 303
  New York, NY 10128
  www.renalresearch.com