Loading
             
                Get Apria Portable Oxygen Concentrator Order Form
How it works
- 
                    Open form follow the instructions
- 
                    Easily sign the form with your finger
- 
                    Send filled & signed form or save
How to fill out the Apria Portable Oxygen Concentrator Order Form online
Filling out the Apria Portable Oxygen Concentrator Order Form online is an essential step for securing a portable oxygen unit for your travel. This guide will provide detailed instructions for each section of the form, ensuring a smooth submission process.
Follow the steps to complete your order form efficiently.
- Click ‘Get Form’ button to obtain the form and open it in the editor.
- Begin by filling out the 'Patient Information' section. Input the patient's name, primary phone number, and address, including city, state, and zip code. Next, include the destination and method of travel.
- Indicate the hours of oxygen use required during travel. Fill in the departure and return dates to complete this section accurately.
- Obtain a prescription from a healthcare provider for the portable oxygen concentrator by having them complete the attached 'Portable Oxygen Concentrator Prescription and Physician Statement of Necessity.'
- Submit both the completed information page and the prescription to your local Apria Healthcare branch for processing. Ensure all required information is accurate.
- After your branch processes the request, Apria Healthcare will confirm availability of the unit and contact you regarding responsibilities and cost. Be prepared to secure the unit with a credit card.
- Upon confirmation, the unit will be shipped to the designated local branch. You can pick it up on the agreed date, typically the last business day before your departure.
- Remember to return the unit on the indicated return date to avoid incurring late charges. Ensure all details are confirmed to avoid delays.
Start filling out the Apria Portable Oxygen Concentrator Order Form online today to ensure your needs are met before your trip.
Oxygen concentrators do not need refilling, but they require regular maintenance to operate efficiently. You need to check the filters and ensure that the device is clean. By utilizing the Apria Portable Oxygen Concentrator Order Form, you can easily find a unit that simplifies oxygen delivery without the hassle of refilling.
Industry-leading security and compliance
US Legal Forms protects your data by complying with industry-specific security standards.
        - 
                    In businnes since 199725+ years providing professional legal documents.
- 
                    Accredited businessGuarantees that a business meets BBB accreditation standards in the US and Canada.
- 
                    Secured by BraintreeValidated Level 1 PCI DSS compliant payment gateway that accepts most major credit and debit card brands from across the globe.