Get Logisticare Standing Order Form 2020
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How to fill out the Logisticare Standing Order Form online
Filling out the Logisticare Standing Order Form online is a straightforward process that can be completed in a few easy steps. This guide will walk you through the necessary sections and fields to ensure you provide all required information accurately.
Follow the steps to complete the form successfully.
- Click ‘Get Form’ button to obtain the form and open it in your preferred editor.
- Begin by filling in the member's name and insurance ID number in the designated fields. Make sure to double-check this information for accuracy.
- Indicate the member's gender and date of birth by selecting the appropriate options.
- In the appointment information section, select the appointment days by checking the corresponding boxes for Monday through Sunday. Specify the appointment and return times, selecting AM or PM as applicable.
- Choose the level of service required by toggling the selections for Ambulatory, Wheelchair, BLS, Mass Transit, Stretcher, ALS, or Gas Reimbursement. If opting for Stretcher/BLS/ALS, provide any necessary precautions.
- Fill in the start and end dates for the service period. If the service is ongoing, indicate this accordingly.
- Detail any special needs of the member in the provided field. Additionally, indicate whether the member can sign the driver’s log and if that signature status will be permanent by selecting yes or no.
- Complete the pick-up and drop-off information by providing the facility or complex name, phone number, and complete address including city, state, and zip code for both locations.
- Select the treatment type from the options given (Dialysis, Substance Abuse, Mental Health, Adult Day Care, or Other) and enter the requesting party's name and title, along with their phone number and fax number.
- Finally, ensure the name, signature, and date fields at the bottom of the form are filled out completely.
- Review the entire form for accuracy. Once completed, you can save your changes, download the form, print it, or share it as needed.
Complete your Logisticare Standing Order Form online today for efficient processing!
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Typically, a standing order can be written by a healthcare provider, such as a physician or nurse practitioner, who is licensed to provide medical orders. It is vital that the authorizing individual understands the patient's needs and the intent of the Logisticare Standing Order Form. This ensures proper care and compliance with regulations.
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(Please fax to the number provided at least 48 hours before the initial trip). FAX: 1-. Do not further disclose.
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