Forms
 
In order for an insurance carrier to cover and pay for supplies and/or equipment, medical necessity must be validated from the patient's medical history. This means when an ordering provider prescribes an item, they should also be noting it in their chart with a reason why. For example, a patient needs a blood pressure monitor for home use. The doctor should 1) write a prescription for the blood pressure monitor 2) note in the patients chart they prescribed a blood pressure monitor due to their high blood pressure, etc which requires monitoring. Your medical records provide context (ie reason for medical necessity) for the item the physician prescribed/ordered.
 
 
Equipment
 
Automatic Blood Pressure Monitor Order Form (Medi-Cal Only)
 
Bath Equipment Order Form (Medi-Cal Only)
 
Sliding Transfer Bench/Hand Held Shower (Medi-Cal Only)
 
 
Incontinence Supplies
 
Incontinence Supplies Order Form (Medi-Cal Only)
 
Wipes/Gloves (Medi-Cal Only)
 
 
Ostomy Supplies
 
Ostomy Supplies Order Form - 1 Piece System
 
Ostomy Supplies Order Form - 2 Piece System
 
 
Tracheostomy Supplies
 
Tracheostomy Supplies Order Form
 
 
Urostomy Supplies
 
Urostomy Supplies Order Form - 1 Piece System
 
Urostomy Supplies Order Form - 2 Piece System
 
 
Urological Supplies
 
Condom Catheter Supplies Order Form
 
Indwelling Catheter Supplies Order Form
 
Intermittent Catheter Supplies Order Form


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