Get Apria Dme Order Form Pdf

Filling out the Apria Dme Order Form Pdf online can streamline the process of ordering necessary home health equipment. This guide provides clear instructions to help you complete the form accurately and efficiently.

Follow the steps to complete the Apria Dme Order Form Pdf

1. Click the ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin filling out the 'Home Sleep PAP Provider' section by entering the provider's name. Follow this with the referral details required for insurance purposes, including the insurance provider and any additional information needed.
3. In the 'Patient Information' section, fill in the date, patient's name, office name, date of birth, home phone number, and the office contact name. It is also important to include mobile and fax numbers, as well as the preferred language details.
4. Ensure that all relevant patient demographics and insurance information are included as required.
5. Complete the 'Sleep History and Physical Exam' section, ensuring at least one symptom of sleep disordered breathing is checked. Fill in the patient's height, weight, BMI, and neck circumference as these are critical for insurance requirements.
6. In the 'Focused Cardiopulmonary / Upper Airway Exam' section, check at least one symptom that is applicable to the patient. This is also necessary for insurance processing.
7. Proceed to the 'Sleep Epworth Exam' and rate the patient's chance of dozing in various situations. This will help in assessing the patient's sleep quality.
8. In the 'Diagnostic Orders' section, indicate whether the patient requires testing on oxygen or room air, adhering to the specified requirements.
9. Fill in the diagnosis code in the 'Diagnosis — ICD-9' section, including any additional diagnoses if necessary.
10. Complete the 'Sleep Therapy' section by stating the type of CPAP equipment recommended and any opt-out choices for further communication regarding the prescription.
11. Finally, sign the form and include the practitioner's name and NPI number, confirming the authorization for the prescription. Include the date of signing to validate the document.
12. Once all sections are completed, save your changes, download, print, or share the form as needed.

Complete your Apria Dme Order Form Pdf online today for an efficient and streamlined ordering process.