Pain Rehab Products Inc 2339 Weldon Pkwy Saint Louis, MO-2025

1. Click ‘Get Form’ to open the Prescription & Certificate of Medically Necessity in the editor.
2. Begin by entering the Patient’s Name and Date of Birth in the designated fields. Ensure accuracy for proper identification.
3. Fill in the Patient’s Address completely to facilitate communication and delivery of equipment.
4. Input the Diagnosis Codes ICD-10, specifying both Primary and Secondary codes as applicable to ensure medical necessity is documented.
5. Select the appropriate Knee Scooter option by checking the box next to 'Knee Rover Knee Scooter' and provide the Surgery Date.
6. The Physician must complete their section by signing and dating the form. Remember, stamped signatures are not acceptable.
7. 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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