MEDICARE REQUIRED PAPERWORK

"let Jay make it very easy for you!"

For Medical Paperwork and Medicare Questions,

 please call 800-727-1954

Ask for:

Jay Rajendra, Medicare Specialist

Hours: Monday thru Thursday 10 - 6, Sat 10-4

 

SALES

MEDICARE Intake/Delivery

medicare lift chairsSEAT LIFT CHAIRS

Lift Chair Instructions for Reimbursement (pdf)

Certificate of Medical Necessity Medicare Form (pdf)

Advance Beneficiary Notice (pdf)

Medical Prescription

medicare hospital bedsHOSPITAL BEDS FORMS

Medical Prescription

Advance Beneficiary Notice (pdf)

Patient CHART/MEDICAL NOTES from doctor

medicare power wheelchair electric wheel chairPOWER CHAIRS AND SCOOTERSmedicare electric scooters

Advance Beneficiary Notice (pdf)

PERSCRIPTION

Power Chair/ Scooter: What your Doctor needs to know (pdf)

Power Chair/Scooter: Face to Face Meeting (pdf)

Power Chair/Scooter: Letter to Doctor (pdf)

FACE TO FACE REPORT

PATIENT CHART/MEDICAL NOTES

DETAILED PRODUCT DESCRIPTION

CUSTOMER INFORMATION

26 Supplier Standards (pdf)

HIPAA PRIVACY Manual (pdf)

PATIENT BILL of RIGHTS and RESPONSIBILITIES (pdf)

Falls, Fire and Home Safety (pdf)

Patient Satisfaction Survey (pdf)

 

 

For Medical Paperwork and Medicare Questions,

 please call 800-353-9917

Ask for: Tina