Get the up-to-date 272 EQ DME Non Wheelchair - KEPRO / NHMedicaid Home 2025 now

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The document is a New Hampshire Medicaid Medical Equipment Request Evaluation Form for non-wheelchair equipment. It requires completion by a licensed physician, occupational therapist, or physical therapist who understands the recipient's condition. The form collects information about the recipient, the requested equipment, medical justification, and details regarding current equipment. It aims to assess the medical necessity of the requested equipment and facilitate approval for Medicaid coverage.

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