Get 1800cpap Consultation Form

The 1800cpap Consultation Form is an essential document for individuals seeking a prescription-required device or supplies from 1800CPAP.com. This guide provides comprehensive instructions on how to complete the form online, ensuring that your information is accurately submitted.

Follow the steps to complete the 1800cpap Consultation Form online.

1. Press the ‘Get Form’ button to obtain the 1800cpap Consultation Form and open it in your preferred editor.
2. Fill in the 'Ordering Physician' section with the physician's name, license number, address, phone number, and fax number. Ensure that all details are correct as this information is vital for processing.
3. Complete the 'Requesting DME Provider' section. Choose 'Ohio Sleep Awareness LLC' and provide the necessary details including the corresponding respiratory license number and tax ID.
4. Enter the 'Patient Name' and 'Date of Birth' accurately to avoid any discrepancies. Include the particular 'Order Number' related to the patient's request.
5. Specify the 'Preferred CPAP Device Manufacturer' and select the desired therapy device from the available options. This information helps in streamlining the order according to the patient's needs.
6. In the 'CPAP/AutoCPAP/Bi-Level' section, fill in the required details regarding pressure settings, ramp time, and any specific preferences for EPR or Flex settings.
7. Provide information related to the 'CPAP Mask/Patient Interface'. Specify the chosen mask name and size to ensure comfort and effectiveness during therapy.
8. For supplies and accessories, indicate any additional items needed for the proper use of the device, including heated humidifiers and other essential materials.
9. Detail the 'Duration of Use' by marking the appropriate option, whether lifetime or limited duration, and specify the exact years and months if relevant.
10. Finally, the physician must sign the form, including the date of signing and their NPI number. This step is crucial for validating the prescription.
11. Once the form is thoroughly completed, save the changes and proceed to download, print, or share the form as necessary. Ensure that a copy is faxed to (888)290-6188 for processing.

Start completing your 1800cpap Consultation Form online today for a seamless ordering experience.