Follow the steps to accurately complete the AADL10939 Form online.

1. Click ‘Get Form’ button to access the AADL10939 Form and open it in your chosen editor.
2. Provide the Client's name, personal health number, and date of birth as they appear on their Alberta Personal Health Card. Include the Client's address, postal code, and contact number.
3. Enter the details of the Respiratory Assessor including their name, designation, facility name, and contact information. It is important that the Respiratory Assessor certifies the accuracy of the provided information.
4. If the Client is currently in a hospital, list the hospital’s name, the unit or station where they are located, and their tentative discharge date.
5. Indicate the current diagnosis for the Client. If the diagnosis involves rapidly progressive neuromuscular conditions, ensure to include specific details as required in the form.
6. For Clients requesting BPAP for rapidly progressive neuromuscular conditions, confirm that one of the listed medical criteria is met, providing necessary documentation as attachments.
7. For Clients with stable or slowly progressive conditions, ensure that one of the requirements is satisfied as specified in the form and attach relevant documentation.
8. Fill in the prescribed BPAP settings including mode, IPAP, EPAP, and any other specific parameters.
9. Select the preferred BPAP Specialty Supplier based on the Client’s needs and prior relationship.
10. Indicate if the Client requires oxygen in conjunction with the BPAP and identify the Oxygen Specialty Supplier.
11. Provide the prescribing physician’s name, contact information, and signature to validate the request, ensuring it is signed by a certified pulmonologist.
12. Add any comments or additional information if necessary to give more context to the request.
13. Once all sections are accurately filled, save changes to the form. You may download, print, or share the completed document as needed.

Complete your documents online today to facilitate the funding process.