Follow the steps to complete your form accurately

1. Click ‘Get Form’ button to obtain the document and open it in the appropriate editor.
2. Complete Section I – Physician Information. Ensure that the ordering physician is SoonerCare contracted, and fill in their printed name, provider ID or NPI, contact name, and phone number.
3. In Section II – Member Information, enter the member's name, member ID, date of birth, address, and phone number. This section is essential for identifying the individual requiring supplies.
4. Specify the type of incontinence in Section II - choose from urinary, bowel, or both. Indicate the expected length of need in months or lifetime.
5. Proceed to Section III and input the member's weight and sex appropriately.
6. Fill in the diagnosis codes in Section IV. Ensure to include the incontinence diagnosis code alongside other related medical diagnosis codes.
7. In Section V, describe the member's mobility status by selecting one of the options: ambulatory without assistance, ambulatory with assistance, or non-ambulatory.
8. Review Section VI to indicate the cognitive function regarding toileting needs. Choose whether the individual is able or unable to communicate their needs.
9. In Section VII, specify the absorbent products ordered, including the quantity required per month for each type, such as diapers, pull-ons, liners, underpads, and wipes.
10. Finally, Section VIII requires the physician's signature and the date of signing. Once everything is completed, review the form for accuracy.
11. Upon completion of all fields, you can save changes, download, print, or share the form. Send it via email to DME@peoplefirstinc.org or fax it to the provided numbers.

Complete your Physician Order For Incontinence Supplies online today to ensure timely access to necessary products.