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Phoenix, AZ 85009-4178

Phoenix, AZ 85009-4178-2026

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The document outlines the requirements and procedures for prescribing manual wheelchairs under Medicare. It includes patient information needed, instructions for completing a Detailed Written Order, and guidelines for documenting mobility limitations and the necessity of a wheelchair over other mobility aids. Additionally, it provides a list of wheelchair types and accessories with qualifying criteria, emphasizing the importance of proper documentation to ensure coverage.

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Click ‘Get Form’ to open the Phoenix, AZ 85009-4178 document in the editor.
Begin by filling out the Patient Information section. Enter the patient's name, address, city, state, zip code, telephone number, date of birth (D.O.B.), Medicare number, and any secondary insurance details.
In the Physician Use Only section, ensure you provide a detailed prescription for a manual wheelchair. Include specific types of wheelchairs based on patient needs and any accessories required.
Complete the chart notes outlining the patient's mobility limitations and how these affect daily living activities. Clearly state why a walker is insufficient and how a wheelchair will enhance mobility.
Finalize by signing and dating the order in the designated areas. Ensure all fields are completed as Medicare requires all elements to be filled out accurately.

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What is Phoenix, AZ called?

The Phoenix metropolitan areathe Valley of the Sunstands at an elevation of 1,100 feet (335 metres) above sea level. The northern and eastern ends of this valley rise into the surrounding volcanic peaks; the remainder is level terrain, dotted with small volcanic mountains of granite and schist.