Get Omnipod 12907-aw 2016-2025

This guide provides a comprehensive overview of filling out the Omnipod 12907-AW reimbursement form online. Follow these clear and detailed steps to ensure a smooth submission process.

Follow the steps to complete your Omnipod 12907-AW form online.

1. Press the ‘Get Form’ button to access the form and open it in your preferred editor.
2. In the 'Remit to Name' section, enter the name of the individual trainer or the clinic/office you are associated with.
3. Provide your contact information including phone number, address, email address, city, state, cell phone number, and ZIP code.
4. For the 'Omnipod® Customer' section, fill in the name, phone number, address, email, city, state, and ZIP code of the customer who received the training.
5. Indicate training types by selecting options such as 'Pre-Pod Training', 'Saline/ Start', or 'Follow-Up Training'. For each type, fill in the required fields including date(s), number of patients, and corresponding sums.
6. Enter any additional expenses incurred, such as mileage, parking/tolls, and provide details as necessary.
7. If applicable, document items requiring pre-approval, such as hotel, meals, and transportation costs with the total amounts.
8. Confirm if any expenses were shared across other trainings by selecting 'yes' or 'no' and providing names if applicable.
9. Complete the form by signing as the trainer and date. Ensure to include Insulet approval signatures where necessary.
10. Once all sections are complete, save your changes, download a copy, and print or share the form as needed.

Complete your Omnipod 12907-AW form online today to ensure timely reimbursement.