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Get Dfec Physical Therapy/occupational Therapy Authorization Request 2019-2026
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How to fill out the DFEC Physical Therapy/Occupational Therapy Authorization Request online
This guide will help you navigate the process of completing the DFEC Physical Therapy/Occupational Therapy Authorization Request online. By following these steps carefully, you will ensure that your request is submitted accurately and efficiently.
Follow the steps to complete your authorization request smoothly.
- Click ‘Get Form’ button to obtain the form and open it in the editor.
- In Part A: Requestor Information, select whether this is an initial request or a correction. Fill in the original authorization number if applicable, the date requested, your name, and phone number.
- In Part B: Claimant Information, enter the claimant's case ID, date of birth, first name, last name, and date of injury.
- In Part C: Provider Information, input the service rendering provider's OWCP ID, Tax ID, name, and fax number. Indicate if you are providing care for a family member and specify the relationship if applicable.
- In Part D: Therapy Plan Information, specify the body part to be treated and enter up to four diagnosis codes. Indicate if the therapy is related to post-operative treatment within 60 days. For each procedure, fill in details like service start and end dates, type of procedure, modifiers, number of units per procedure, frequency, duration, and total units requested.
- In Part E: Supporting Documents, ensure that all required supporting documentation, such as the physician's prescription and treatment plan, is attached. Remember to include the claimant ID on each page.
- Review the completed form for accuracy before submission. After ensuring all details are correct, you may save changes, download, print, or share the form as necessary.
Start filling out your DFEC Physical Therapy/Occupational Therapy Authorization Request online today.
Writing an authorization form requires clear and concise language. Begin with your full details and specify what you are authorizing, including references to the DFEC Physical Therapy/Occupational Therapy Authorization Request. Utilizing uslegalforms as a resource can help you stay organized and ensure you include all necessary information for a successful submission.
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