Forms
Necessary Information for insurance patients
Copy of ID
Copy of Insurance cards
(If a Resident of a Facility, include a Face Sheet)
Contact information for person financially responsible
Completed and Signed Prescription
ICD-10 codes
This list will help us classify and code all diagnoses, symptoms and procedures recorded in conjunction with hospital care in the United States.
Oxygen Prescription Form
Your insurance company will require all information to be supplied. This form will help document the medical necessity and other coverage criteria for selected durable medical equipment, prosthetics, orthotics, and supplies.
DME Prescription Form
Your insurance company will require all information to be supplied. This form will help document the medical necessity and other coverage criteria for selected durable medical equipment, prosthetics, orthotics, and supplies.
Patient Information Packet
The Patient Information Packet covers topics such as Billing & Payment, Emergency Preparedness, Patient/Client Bill of Rights, Home Safety Tips and Medicare Supplier Standards.