Get Cervical Traction Unit Lomndoc - Goldenstatemedical

Filling out the Cervical Traction Unit LOMNdoc - Goldenstatemedical is a straightforward process that ensures the necessary information is provided for the prescribed equipment. This guide will walk you through each section of the form to facilitate a smooth completion.

Follow the steps to complete the Cervical Traction Unit LOMNdoc online

1. Click ‘Get Form’ button to retrieve the Cervical Traction Unit LOMNdoc and open it in the document editor.
2. Begin by filling in the patient's name and date of birth accurately in the designated fields. Ensure that the information matches official documents to avoid any discrepancies.
3. In the purchase section, input the corresponding ICD code(s) to indicate the diagnosis pertinent to the cervical traction unit.
4. Indicate whether the injury is related to Workers’ Compensation or a Motor Vehicle Accident by selecting 'Yes' or 'No' in the provided checkboxes.
5. Provide answers to the questions regarding the patient's need for traction equipment. Each question must be answered with either 'Yes' or 'No' to justify the medical necessity of the prescribed device.
6. Ensure the physician's signature is captured along with the date of signing, physician's name, NPI number, and contact information including address and phone number.
7. After reviewing all entries for accuracy, save any changes made to the document. You can then download, print, or share the completed form as required.

Complete your Cervical Traction Unit LOMNdoc online today for efficient processing.