MEDICARE REQUIRED PAPERWORK
"let Jay make it very easy for you!"
For Medical Paperwork and Medicare Questions,
please call 800-233-7382
Ask for:
Jay Rajendra, Medicare Specialist
Hours: Monday thru Thursday 10 - 6, Sat 10-4
SALES
SEAT LIFT CHAIRS
Lift Chair Instructions for Reimbursement (pdf)
Certificate of Medical Necessity Medicare Form (pdf)
Advance Beneficiary Notice (pdf)
Medical Prescription
HOSPITAL BEDS FORMS
Medical Prescription
Advance Beneficiary Notice (pdf)
Patient CHART/MEDICAL NOTES from doctor
POWER CHAIRS AND 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 800-233-7382
Ask for:
Jay Rajendra, Medicare Specialist
Hours: Monday thru Thursday 10 - 6, Sat 10-4
"let Jay make it very easy for you!"
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