Get Cpap Assistance Program Application

Completing the CPAP Assistance Program Application online can be a straightforward process if you follow the right steps. This guide is designed to help you navigate through each section of the form clearly and effectively.

Follow the steps to successfully complete the application.

1. Click ‘Get Form’ button to access the application and open it in your preferred editor.
2. Provide the prescribing physician's information by filling in the NPID, full name, address, phone number, and email address. Ensure that the email address is correct, as it will be used to send UPS tracking information.
3. Enter the patient information, including their name, address, phone number, and email address. If a social worker is involved, include their name and contact number.
4. Complete the shipping information section. Specify the address where the equipment should be sent, including any relevant suite or department details and a contact number.
5. Indicate the type of equipment package needed. Select from CPAP, APAP, or BiLevel options. Fill in the required pressure settings or ranges if applicable.
6. Choose the mask size and style as per the patient's needs. Note any additional instructions for comfort settings in the comments section.
7. The prescribing physician must acknowledge their involvement by signing the necessary acknowledgment section. This confirms their license to prescribe the medical device and releases ASAA from liability.
8. After reviewing the completed form for accuracy, save your changes. You can then download, print, or share the application as needed.

Complete your application online today to begin the CPAP Assistance Program process.