Get New Ostomy Order Form Website.pub - Prism Medical Products

Filling out the New Ostomy Order Form is an important step in ensuring you receive the necessary supplies for your ostomy care. This guide will assist you in completing the form accurately and efficiently, ensuring that all required information is provided.

Follow the steps to complete your New Ostomy Order Form online.

1. Press the ‘Get Form’ button to access the form and open it in your preferred document editor.
2. Begin by entering the patient's name in the designated section at the top of the form, ensuring to include the complete first and last name.
3. Fill in the referring facility details, including the facility's phone and fax numbers. This information will help streamline communication regarding the order.
4. Input the RX date, providing clarity on when the prescription is written.
5. Indicate whether the patient is currently utilizing Home Health Services by selecting either 'Yes' or 'No' from the provided options.
6. Confirm if the patient has any latex allergies by selecting 'Yes' or 'No'. This is crucial for selecting compatible products.
7. Choose the appropriate ostomy pouch type by checking the relevant box for either the One Piece or Two Piece option. Include any brand or part numbers if available.
8. For each item required, indicate the estimated time of need by selecting the appropriate size (4x4, 6x6, or 8x8) where applicable.
9. Document the patient's diagnosis by selecting from the provided codes or writing in any other relevant diagnosis.
10. Fill in the stoma size and other materials required, ensuring you check the boxes for adhesive remover wipes, skin prep wipes, tape, or any other necessary items.
11. In the notes section, any additional remarks can be included that may assist in the processing of this order.
12. Obtain the required approvals by having both the patient and physician sign in the designated sections, ensuring that all signatures are completed.
13. Finally, save any changes made to the form. You may then download, print, or share the completed document as needed.

Complete your New Ostomy Order Form online today to ensure timely access to your essential ostomy supplies.