Get Worryfree Dme Sm Diabetic Shoe Order Entry Form - Safestep

This guide provides detailed instructions for completing the WorryFree DME SM Diabetic Shoe Order Entry Form online. Filling out the form accurately is important to ensure compliance with Medicare requirements and facilitate the provision of diabetic shoes for users.

Follow the steps to fill out the form correctly.

1. Click the ‘Get Form’ button to retrieve the form and open it in your preferred editing tool.
2. Begin filling out the Patient Evaluation section. This includes providing basic information about the user, such as name, address, phone number, and insurance details.
3. Input medical history information, including the type of diabetes, history of amputations, or any foot deformities. This information is crucial for determining eligibility.
4. Complete the Shoe Ordering Information section. Measure the user's feet to determine shoe size and select the appropriate shoe and insert options based on comfort and stability.
5. Have the certifying physician complete and sign the required forms, including the Physician Notes on Qualifying Condition(s) and the Statement of Certifying Physician.
6. Once the required physician documentation is complete, check all information for accuracy and compliance with Medicare standards.
7. After reviewing, you can save the form. Consider downloading or printing a copy for your records, and ensure to provide any necessary documents to the user.

Encourage others to manage their diabetic shoe orders online through SafeStep.