DME Orders

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MANUAL WHEELCHAIR ORDER PROCESS

STEP 1 - SCHEDULE A FACE-TO-FACE OFFICE VISIT WITH THE PATIENT- REFERENCE GUIDE
STEP 2 - ORDERING PHYSICIAN COMPLETES THE STANDARD WRITTEN ORDER (SWO)

STEP 3 - FAX SWO AND CHART NOTES FROM PATIENT'S FACE-TO-FACE MOBILITY EXAM TO 704-821-7777

 

(If NC Medicaid is the primary insurance we will also need the NC Medicaid CMN/PA completed, signed by ordering physician and faxed to 704-821-7777 along with the SWO and chart notes from the patient's face-to-face)
 

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MOBILITY SCOOTER (POV) ORDER PROCESS

 

STEP 1 - SCHEDULE A FACE-TO-FACE OFFICE VISIT WITH THE PATIENT - Ordering Physician Letter & Checklist
STEP 2 - ORDERING PHYSICIAN COMPLETES THE STANDARD WRITTEN ORDER (SWO) (ORDER MUST BE COMPLETED IN SAME HANDWRITING)
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TEP 3 - FAX SWO AND CHART NOTES FROM PATIENT'S FACE-TO-FACE MOBILITY EXAM TO 704-821-7777

(If NC Medicaid is the primary insurance we will also need the NC Medicaid CMN/PA completed, signed by ordering physician and faxed to 704-821-7777 along with the SWO and chart notes from the patient's face-to-face)

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MOTORIZED WHEELCHAIR ORDER PROCESS

 

STEP 1 - SCHEDULE A FACE-TO-FACE OFFICE VISIT WITH THE PATIENT - Ordering Physician Letter & Checklist
STEP 2 - ORDERING PHYSICIAN COMPLETES THE STANDARD WRITTEN ORDER (SWO) (ORDER MUST BE COMPLETED IN SAME HANDWRITING)
STEP 3 - FAX THE SWO AND THE CHART NOTES FROM FACE-TO-FACE 
OFFICE EXAM TO 704-821-7777

(If NC Medicaid is the primary insurance we will also need the NC Medicaid CMN/PA completed, signed by ordering physician and faxed back along with the SWO and chart notes from the patient's face-to-face)

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LIFTCHAIR MECHANISIM ORDER PROCESS

STEP 1 - SCHEDULE A FACE-TO-FACE OFFICE VISIT WITH THE PATIENT- REFERENCE GUIDE
STEP 2 - ORDERING PHYSICIAN COMPLETES THE STANDARD WRITTEN ORDER (SWO)

STEP 3 - ORDERING PHYSICIAN COMPLETES THE MEDICARE CMN

STEP 4 - FAX SWO, CMN, AND CHART NOTES FROM PATIENT'S FACE-TO-FACE MOBILITY EXAM TO 704-821-7777
 

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BACK BRACE SUPPORT ORDER PROCESS

STEP 1 - SCHEDULE A FACE-TO-FACE OFFICE VISIT WITH THE PATIENT- REFERENCE GUIDE
STEP 2 - ORDERING PHYSICIAN COMPLETES THE STANDARD WRITTEN ORDER (SWO)

STEP 4 - FAX SWO, AND CHART NOTES FROM PATIENT'S FACE-TO-FACE MOBILITY EXAM TO 704-821-7777
 

FOR ALL OTHER DME ORDER REQUEST COMPLETE THE GENERAL DME SWO AND FAX TO 704-821-7777 ALONG WITH CHART NOTES FROM FACE-TO-FACE VISIT WITH PATIENT