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Pain Rehab Products Inc 2339 Weldon Pkwy Saint Louis, MO-2026
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- Click ‘Get Form’ to open the Prescription & Certificate of Medically Necessity in the editor.
- Begin by entering the Patient’s Name and Date of Birth in the designated fields. Ensure accuracy for proper identification.
- Fill in the Patient’s Address completely to facilitate communication and delivery of equipment.
- Input the Diagnosis Codes ICD-10, specifying both Primary and Secondary codes as applicable to ensure medical necessity is documented.
- Select the appropriate Knee Scooter option by checking the box next to 'Knee Rover Knee Scooter' and provide the Surgery Date.
- The Physician must complete their section by signing and dating the form. Remember, stamped signatures are not acceptable.
- Finally, follow instructions to either call or fax the completed script along with demographics and insurance information to (314) 832-1430.
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| Versions | Form popularity | Fillable & printable |
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| 2015 | 4.8 Satisfied (110 Votes) |
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Inspection: 959182.015 - Pain Rehab Products, Inc ; Site Address: Pain Rehab Products, Inc 2339 Weldon Parkway Saint Louis, MO 63146 ; Mailing Address: 2339Read more