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How to use or fill out Wheelchair Seating Mobility ClinicsOhio State Medical Center with our platform
- Click ‘Get Form’ to open the Wheelchair Seating Mobility ClinicsOhio State Medical Center form in the editor.
- Begin by filling out the 'Date form completed' field at the top of the form. This helps track when the referral was made.
- In the 'REFERRAL FOR' section, select all applicable services such as 'Wheelchair Seating/Mobility Assessment' or 'Motor Access to Technology'.
- If applicable, provide the name of the wheelchair supply company in the designated field.
- Complete personal information under 'CLIENT INFORMATION', including client name, date of birth, and primary diagnosis.
- Fill in insurance details under 'MEDICAL INSURANCE / OTHER PAYER INFORMATION', ensuring accuracy for billing purposes.
- Review and sign the CLIENT ACKNOWLEDGMENT AND AUTHORIZATION section to confirm understanding of services and billing.
- Finally, ensure all sections are complete before submitting via fax or email as indicated at the bottom of the form.
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