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1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the patient's date of birth and contact information in the designated fields. Ensure accuracy for effective communication.
3. Fill in the patient’s name, prescription details, and medical necessity certification. This section is crucial for validating the prescribed equipment.
4. Specify the length of need for each device by selecting from options like 'Lifetime' or '3-18 Months'. If applicable, check additional boxes for specific treatments.
5. Complete the sections regarding insurance type and provider details. This ensures proper billing and coverage for the prescribed devices.
6. Review all entries for accuracy before signing. Use our platform's tools to add your signature and printed name where required.

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