Get Apria Dme Order Form Pdf

Filling out the Apria Dme Order Form Pdf online can be a straightforward process when you have the right guidance. This guide provides you with clear, step-by-step instructions to help you complete each section of the form efficiently and accurately.

Follow the steps to complete the Apria Dme Order Form Pdf online.

1. Click the ‘Get Form’ button to access the Apria Dme Order Form Pdf and open it in your preferred editor.
2. Begin by entering the courier information at the top of the form. Provide the name and city of the equipment courier along with their state.
3. In the patient information section, fill in the patient’s name, date of birth, phone number, and social security number. Ensure that you provide accurate information.
4. Indicate the patient's gender by selecting the appropriate box. Fill out the mailing address and email of the patient as well.
5. Next, provide the primary and secondary insurance information. Enter the insurance identifiers as needed.
6. Answer whether the testing is being performed in a skilled nursing facility by selecting 'Yes' or 'No'.
7. In the prescription/diagnosis section, the physician must complete this portion. Fill in the description of services required with the corresponding codes.
8. The physician must indicate the diagnosis of medical necessity by checking the relevant conditions and providing any additional diagnosis in the space provided.
9. Complete the physician information section by entering the physician's name, NPI, UPIN, phone, fax, email, and mailing address.
10. Ensure that the physician reviews and signs the attestation section, confirming the accuracy of the provided information.
11. Finally, after ensuring all fields are correctly filled, you may save changes, download, print, or share the form as required.

Complete the Apria Dme Order Form Pdf online today for a seamless experience.