Bedard Medical Supplies - 359 Minot Ave, Auburn, ME - Yelp 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the Patient Name, Date of Birth (DOB), and Phone Number in the designated fields. Ensure accuracy for proper processing.
3. Fill in the Facility name and Fax number. This information is crucial for communication regarding the order.
4. Select the Primary Diagnosis/ICD-10 Code from the provided list. If your diagnosis is not listed, specify it in the 'Other' field.
5. Indicate the Length of Need and Refills required. Choose between 'Lifetime' or specify another duration.
6. Answer whether the patient has a latex allergy and if they are currently being seen by home health services.
7. In the UROLOGY SUPPLIES NEEDED section, select the items required, including type, size, and quantity for each item.
8. Complete any additional notes or specifications that may assist in processing your order effectively.
9. Finally, provide Physician Name, NPI number, phone number, fax number, and signature along with the date to validate the order.

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