Get Call: (877) 775-3377

This guide provides a clear and comprehensive overview of how to complete the Call: (877) 775-3377 form online. By following the steps outlined below, users can effectively navigate the form and ensure that all necessary information is accurately provided.

Follow the steps to successfully complete the form.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by filling out the patient information section. Enter the patient’s name, date of birth, gender, height, weight, address, city, state, ZIP code, best contact number, alternate contact number, and email.
3. In the prescribed services section, check the appropriate boxes for the requested services. If applicable, include the CPT codes for each service by referencing the relevant codes provided in the form.
4. Complete the durable medical equipment section if needed. Indicate the type of equipment (e.g., CPAP, Bilevel PAP, etc.) and provide the necessary device settings and duration of need.
5. Fill out the diagnosis and history & symptoms sections with any relevant details regarding the patient’s condition and sleep-related symptoms.
6. In the referring physician information section, provide the physician's name, phone number, fax number, NPI number, office contact person, and signature, along with the date.
7. After completing all sections, review the form for completeness and accuracy. Save changes, download, print, or share the completed form as necessary.

Complete your documents online today for efficient submission!