Get Hill Rom Vest Order Form

Filling out the Hill Rom Vest Order Form online is a straightforward process that ensures accurate information is submitted for your airway clearance system needs. This guide provides clear steps to complete the form effectively, ensuring all necessary fields are filled out correctly.

Follow the steps to successfully complete the order form online.

1. Press the ‘Get Form’ button to access the form and open it in the online document management system.
2. Begin by entering the facility contact person's name and patient details, including their name, birth date, and gender. Ensure all fields marked as required are completed accurately.
3. Fill in the patient's address, including the street, city, state, and zip code, along with the patient's phone number and email address.
4. Provide details about the physician or primary care provider, including their name, phone number, and email.
5. Indicate primary and secondary insurance information, including the insurance name and identification numbers.
6. Complete the section for chest measurement, garment style, and the last date the patient was seen by a healthcare provider.
7. Answer the questions regarding the patient's hospital status and the discharge date if applicable.
8. Provide information for the healthcare provider section, where they must indicate whether alternative airway clearance techniques were tried and provide relevant medical history.
9. The prescriber needs to provide a signature and date, along with any necessary medical documentation that supports the need for the device.
10. Once all sections are completed, review the form for accuracy and save your changes. You may also download, print, or share the completed form as needed.

Complete your order form online today to ensure timely processing and delivery of the Hill Rom Vest.