Get Power Mobility Devices - 7-element Order

Completing the Power Mobility Devices - 7-Element Order is a crucial step in obtaining necessary mobility equipment. This guide provides clear instructions on how to accurately fill out the online form, ensuring that all required information is properly recorded.

Follow the steps to complete your order effectively.

1. Press the ‘Get Form’ button to access the form and open it in your preferred document editor.
2. Begin by entering the beneficiary's name in the designated field. This should be the name of the individual who will receive the power mobility device.
3. In the 'Item ordered' field, be sure to leave this blank for the physician to fill in. It is crucial that this section is not pre-filled, as it could invalidate the order.
4. Record the date of the face-to-face examination in the appropriate space. Ensure that this date corresponds with the most recent examination by a qualified healthcare provider.
5. In the diagnosis/condition relating to the need for the item section, provide a brief but clear description of the medical reason for the equipment request. This is essential for justifying the need for a power mobility device.
6. Indicate the length of need for the device. This should represent the duration for which the equipment is anticipated to be required by the beneficiary.
7. Ensure the physician signs the form in the designated area, followed by the signature date. Both are necessary to validate the order.
8. After all sections are completed, review the document for accuracy. Save any changes made to the form, and then download or print the completed order for submission.

Complete your Power Mobility Devices - 7-Element Order online today to ensure timely access to your mobility equipment.