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Completing the Certification of Medical Necessity for the Department Of Labor can be a straightforward process when you understand each section of the form. This guide will provide you with step-by-step instructions to ensure you fill out the form accurately and efficiently online.

Follow the steps to successfully complete the form online.

1. Press the ‘Get Form’ button to obtain the necessary document and open it in your chosen editor.
2. Fill in the patient's name and mailing address. Ensure that you include all required components such as the name, street address, city, state, and zip code.
3. Provide the patient's telephone number, social security number, and date of birth.
4. Enter the case ID and the date(s) of the patient's last hospitalization.
5. Outline the condition(s) treated during the hospitalization in the specified fields.
6. Specify the pulmonary condition(s) for which this prescription is issued.
7. Indicate whether the prescription is original or a recertification, and specify the requested duration for any durable medical equipment (DME) or home nursing care.
8. List the equipment or services prescribed based on the guidelines provided, ensuring that you reference item 11 for DOL reimbursement standards.
9. Attach all necessary objective test results. Remember to provide original or certified copies of lab reports related to the pulmonary function test.
10. Fill in the physician/provider information, certifying that the prescribed services are necessary.
11. Review the completed form for accuracy, and sign and date it to complete the submission.
12. Save your changes and choose to download, print, or share the filled form as needed.

Take action now and start filing your documents online to ensure timely processing!