Get Logisticare Standing Order Form Pdf

Filling out the Logisticare Standing Order Form Pdf online can be straightforward when you have the right guidance. This comprehensive guide will walk you through each section of the form to ensure that you complete it accurately and efficiently.

Follow the steps to successfully complete the Logisticare Standing Order Form Pdf online.

1. Click the ‘Get Form’ button to obtain the form and open it in your preferred document editor.
2. In the ‘Ordered By’ section, fill in your name, phone number, title, and fax number as necessary.
3. Provide the member's full name, date of birth, member ID number, and insurance type.
4. Select the treatment days by checking the appropriate boxes for Monday through Sunday, and specify the appointment time and arrival time.
5. Indicate the level of service required by selecting one of the options: ambulatory, wheelchair (and provide weight and height if applicable), door-to-door, or mass transit.
6. Determine if an escort will be traveling with the member by selecting 'yes' or 'no'.
7. Mention any special needs or directions that may assist during the service.
8. Indicate whether the member can sign the driver log and provide a reason if they cannot.
9. Fill in the start date and end date for the service and indicate if it is ongoing.
10. Select the treatment type by checking the appropriate box for adult day care, mental health counseling, wound care, and any other type mentioned.
11. Complete the holiday schedule by selecting the operational status for each holiday listed.
12. Enter the pick-up and drop-off information, providing details such as facility name, address, city, state, and phone numbers.
13. Review all entries for accuracy. Once satisfied, save your changes, download the completed form, or print it to share.

Begin completing the Logisticare Standing Order Form Pdf online now to ensure timely processing.