Get Standard Prescription Form - Rackspace

The Standard Prescription Form - Rackspace is a vital document used to prescribe necessary equipment for patients with sleep-related disorders. This guide will provide detailed instructions to assist users in accurately filling out the form online, ensuring that all required information is completed effectively.

Follow the steps to successfully complete the Standard Prescription Form online.

1. Press the ‘Get Form’ button to obtain the form and open it in the online editor.
2. Begin by entering the ordering physician's information. Fill in the physician's name and address as required.
3. Next, input the supplier details, which includes the name CPAP.com (US Expediters, Inc), fax number 1-866-353-2727, and the address in Stafford, TX.
4. Fill in the patient information section, including the patient's name and date of birth.
5. Provide the diagnosis information. Select from the listed diagnoses such as Obstructive Sleep Apnea or Hypersomnia with sleep apnea.
6. Choose the appropriate machine type(s) that the patient requires from the provided options, indicating if CPAP, BiPAP, or others are needed.
7. Specify the pressure or pressure range for the prescribed machine in the designated fields, ensuring that accurate measurements are used.
8. If applicable, provide details about the humidifier preferences, specifying whether a heated humidifier or other type is preferred.
9. Complete the CPAP mask/interface delivery system section by selecting the preferred type of mask and size.
10. Identify and list all necessary supplies that are required for the proper use of the equipment, referring to the categories provided.
11. Include any additional comments or notes that may be necessary, ensuring clarity about the patient's condition and treatment regulations.
12. The physician must then provide their signature, National Provider Identifier (NPI), license number, and date to validate the prescription.
13. Finally, save the completed form, then download, print, or share it as needed, ensuring it is sent to the designated fax number.

Complete your documents online today by following these easy steps for the Standard Prescription Form.