Most delays on custom garment orders come down to one thing: the progress note doesn't explain why the patient needs custom instead of ready-to-wear. "Patient needs a garment for lymphedema swelling" describes the diagnosis, not the need for custom. Here is what a strong note includes, with sample language you can adapt. For the full document checklist, see our custom garment documentation guide.
What every custom garment note should list
For each garment you recommend, include:
Type: knee high, thigh high, waist length (pantyhose or panty), arm sleeve, gauntlet, night garment
Compression class and pressure: for example class III, or the mmHg range
Description: manufacturer and line, toe (open or closed), top band, zipper, extended foot, special knitting such as Y-heel or a knee panel
Use: daytime or nighttime
Quantity: for example 3 daytime garments, so one can be washed while another is worn
Side: right, left or bilateral
The reason for medical necessity: why this patient's limb can't be fitted with ready-to-wear
The progress note must also carry the lymphedema diagnosis, and it should be signed and dated by the treating provider.
Reasons that support custom
The proximal limb is significantly larger than the distal limb, so a ready-to-wear garment can't fit both
Skin or tissue folds or contours need a specific knitting pattern
Significant fibrotic tissue, or sensitivity in the area
The patient can't tolerate the fabric of a standard garment
A large size difference between the right and left limbs
Foot or toe shape that a ready-to-wear garment can't accommodate
A medical condition that limits pressure in one area, for example abdominal compression with GERD
A reason that does not support custom on its own
"Patient needs a garment for lymphedema swelling." This is true for every lymphedema patient. It doesn't say why ready-to-wear won't work.
Sample language: custom knee highs
"I measured [patient name] today for custom mediven 550 class III knee highs with closed toes, Y-knitting at the heel and a silicone top band. I am recommending 3 knee highs for daytime compression. [Patient name] will need a medial zipper because [his/her] feet are much larger than [his/her] ankles, and [he/she] would not be able to get the stocking on by pushing through the top of the garment."
Sample language: custom night garment
"I am also recommending custom CircAid Profile night garments (thigh) for [his/her] distal legs, adding the E-Z open panel so the garment opens at the front and closes with hook-and-loop. This will make it easier to accommodate the larger foot and the unique shape of the knee. I have requested that the manufacturer extend the foot portion to the end of the toes to give some decongestion to the metatarsal area."
Sample language: custom waist-length garment, one leg
"Patient was measured today for a custom mediven 550 class III gradient compression waist-length garment for daytime use on her right leg. I am recommending 3 custom garments for daytime use. Her shape does not fit ready-to-wear garments: she has a large amount of tissue at the top of the right thigh, the proximal limb circumference is significantly greater than the distal limb, and the right leg is significantly larger than the left. The patient has GERD, so the garment cannot compress too tightly in the abdominal area."
Sample language: custom whole-leg night garment
"I am also recommending a custom CircAid Profile whole-leg garment for her right leg for nighttime use, adding the E-Z open panel so the garment opens at the front and closes with hook-and-loop. This will make donning easier given her age, and will accommodate the larger proximal area and the unique shape and size of the fibrotic tissue in her right leg. These garments are expected to help manage her lymphedema swelling and support mobility and daily living."
Change the bracketed parts and the product details to match your patient. Only document what you actually measured and observed.
Quick checklist before you send
Lymphedema diagnosis in the progress note
Type, class or pressure, description, day or night use, quantity and side for each garment
A specific reason ready-to-wear won't work
Measurement sheet attached
Signed prescription, and a signed addendum if the original note doesn't include this language
Where to send it
Fax the progress note with the diagnosis and garment description, the prescription and any addendum to 800-886-4201. If you placed a custom knee-high order on Parachute Health, upload the progress note to the Parachute order as well, or fax it to 517-299-1014. Questions? Call 800-883-1549. See also our measuring tips for custom flat knit.
Sample language is a starting point for the clinician's own documentation, not a template to copy unchanged. Payer requirements vary.
