Get CPAP Prescription / Letter of Medical Necessity

Com US Expediters Inc Fax 1-866-353-2727 Phone 10101 Stafford Centre Dr Suite B TX License 0062550 Fax Stafford TX 77477 TX Tax ID 760521364 Patient DOB Diagnosis Obstructive Sleep Apnea Adult Pediatric 327. 23 Hypersomnia with sleep apnea unspecified 780. 53 Machine Type s CPAP or APAP E0601 BiPAP / BiLevel / VPAP E0470 VPAPs E0470 Humidifier s Patient Preference Other unspecified sleep apnea 780. 57 Pressure or Pressure Range Heated Humidifier E0562 CPAP Mask/Interface/Delivery System CPAP Mask Patient Preference Other CM/H2O Passover Humidifier E0561 Size All Related Supplies The following dispensable equipment is necessary for the proper use of the equipment and is not a part of the CPAP BiLevel BiLevel ST BiLevel SV or AVAPs machine when purchased and needs to be replaced on a regular basis Full Face Mask A7030 Full Face Cushion A7031 Nasal Mask A7034 Mask Cushion A7032 Nasal Pillows A7033 Headgear A7035 Oral Interface A7044 Chinstrap A7036 Exhalation Port/Swivel A7045 Tubing A7037 Humidifier Chamber A7046 Disposable Filters A7038 Non-Disposable Filters A7039 The above named patient was diagnosed as indicated. Due to the potentially dangerous consequences of disturbed sleep and sleep deprivation which include the possibility of falling asleep in critical situations treatment of this condition is considered mandatory rather than elective on a nightly basis for a long term to lifetime duration 99 months. Prescription / Letter of Medical Necessity Ordering Physician Physician s Address Supplier Supplier Information CPAP. com US Expediters Inc Fax 1-866-353-2727 Phone 10101 Stafford Centre Dr Suite B TX License 0062550 Fax Stafford TX 77477 TX Tax ID 760521364 Patient DOB Diagnosis Obstructive Sleep Apnea Adult Pediatric 327. 23 Hypersomnia with sleep apnea unspecified 780. 53 Machine Type s CPAP or APAP E0601 BiPAP / BiLevel / VPAP E0470 VPAPs E0470 Humidifier s Patient Preference Other unspecified sleep apnea 780. 57 Pressure or Pressure Range Heated Humidifier E0562 CPAP Mask/Interface/Delivery System CPAP Mask Patient Preference Other CM/H2O Passover Humidifier E0561 Size All Related Supplies The following dispensable equipment is necessary for the proper use of the equipment and is not a part of the CPAP BiLevel BiLevel ST BiLevel SV or AVAPs machine when purchased and needs to be replaced on a regular basis Full Face Mask A7030 Full Face Cushion A7031 Nasal Mask A7034 Mask Cushion A7032 Nasal Pillows A7033 Headgear A7035 Oral Interface A7044 Chinstrap A7036 Exhalation Port/Swivel A7045 Tubing A7037 Humidifier Chamber A7046 Disposable Filters A7038 Non-Disposable Filters A7039 The above named patient was diagnosed as indicated* Due to the potentially dangerous consequences of disturbed sleep and sleep deprivation which include the possibility of falling asleep in critical situations treatment of this condition is considered mandatory rather than elective on a nightly basis for a long term to lifetime duration 99 months. Prescription / Letter of Medical Necessity Ordering Physician Physician s Address Supplier Supplier Information CPAP. com US Expediters Inc Fax 1-866-353-2727 Phone 10101 Stafford Centre Dr Suite B TX License 0062550 Fax Stafford TX 77477 TX Tax ID 760521364 Patient DOB Diagnosis Obstructive Sleep Apnea Adult Pediatric 327. .