Follow the steps to complete the Orthonet form.

1. Press the ‘Get Form’ button to access the Orthonet form and open it in your chosen editor.
2. In the 'Therapy Provider Information' section, fill out either the facility name or the provider’s first and last name. Ensure you include the complete street address, city, state, telephone number, return fax number, facility/provider ID number, zip code, National Provider Identifier (NPI), provider tax ID number, and the facility NPI number.
3. Next, move to the 'Patient Information' section. Fill in the first name, last name, and date of birth of the patient. Provide the alpha prefix member ID number as needed.
4. In the 'Request Information' section, specify the request type and enter the diagnosis code in the required ICD-10 format. Indicate if the request is for post-operative therapy visits by selecting 'Yes' or 'No.'
5. Detail the therapy visits precertification or any other procedure that is applicable by filling in the blank provided. Clarify the service type by indicating whether it is for physical therapy or occupational therapy, and enter the initial evaluation date.
6. After reviewing the form for accuracy, save any changes you’ve made. You can also choose to download, print, or share the completed document as required.

Complete your Orthonet documents online today for a streamlined process.