Get Ostomy Quick Start Form T 8004516510 F 8006160203 E

This guide provides a comprehensive overview of how to fill out the ostomy quick start form online. Following these instructions will ensure that you accurately complete each section of the form, facilitating a smooth order process for ostomy products.

Follow the steps to complete the ostomy quick start form online.

1. Press the ‘Get Form’ button to access and open the ostomy quick start form in your preferred online editor.
2. Begin by entering the patient’s name in the designated field. Indicate whether the patient has been notified about and chosen MPCS for their order by selecting ‘Yes’ or ‘No.’
3. Specify if the patient is receiving home health services by marking ‘Yes’ or ‘No.’ If marked ‘Yes,’ provide additional details.
4. Select the patient's preferred language from the available options: English, Spanish, or another option if necessary.
5. Fill in the patient’s date of birth in the appropriate format.
6. For referral information, input the referral number and contact details, including your preferred method of communication, such as phone, email, or fax.
7. Identify the primary diagnosis using the corresponding ICD-10 code. Choose from the provided options, ensuring the primary diagnosis is required.
8. If applicable, fill out the secondary diagnosis with the corresponding ICD-10 code.
9. Select the manufacturer's products relevant to the patient’s needs and fill in the brand or item numbers along with type (e.g., one-piece pouch or two-piece pouch).
10. Indicate the quantity of products required daily and their frequency of use by checking the relevant options.
11. In the certification section, ensure you read and understand the declaration regarding the medical necessity of the order before signing.
12. Once all sections are filled out, review for accuracy. Then, save any changes, download the completed form, print a copy for records, or share it as needed.

Complete your ostomy quick start form online today for a streamlined medical order process.