Get Dme Order Form

Filling out the Durable Medical Equipment (DME) Order Form online is a straightforward process designed to ensure accurate and efficient requests for necessary equipment. This guide will walk you through each section of the form, providing clear instructions to help you complete it effectively.

Follow the steps to fill out the DME Order Form online:

1. Press the ‘Get Form’ button to acquire the form and open it in your web browser.
2. Begin by entering the patient's name in the designated field, followed by their date of birth in the format MM/DD/YYYY.
3. Next, provide the diagnosis and corresponding ICD-9 code in the appropriate fields, along with the patient's height and weight.
4. Indicate the patient's sex by selecting 'M' for Male or 'F' for Female.
5. Specify the length of need for the equipment, selecting either '99' for lifetime or entering a specific duration.
6. Attach any necessary demographics as specified on the form.
7. Select the appropriate equipment needed by checking the relevant boxes under the 'Ambulatory & Other Aids' section, ensuring to provide as much detail as possible.
8. If applicable, record the anticipated date of discharge to help with timely equipment delivery.
9. Fill in the physician's name, contact details, and add their signature along with the date to validate the order.
10. Finally, review all the information entered for accuracy, then proceed to save your changes, download, print, or share the completed form as needed.

Complete your documents online effectively to streamline your process.