Wheelchair Seating Mobility ClinicsOhio State Medical Center: Fill out & sign online

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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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Is Wexner Medical Center part of Ohio State University?

Located on one of the nations most comprehensive health science campuses, The Ohio State University Wexner Medical Center is among the largest academic medical centers in the country and serves as the medical center affiliated with The Ohio State University.

What hospitals are affiliated with Ohio State University?

The Ohio State Health System includes University Hospital and East Hospital, Ohio States two full-service teaching hospitals. Other hospitals include Ohio State Harding Hospital, an inpatient and outpatient psychiatric hospital; the Richard M.

What is a wheelchair clinic?

The number one goal of a wheelchair clinic is to ensure that people using wheelchairs have the most appropriate seating system to meet their physical needs, comfort, and functional requirements.

What is the name of the medical school at Ohio State University?

The Ohio State University College of Medicine (formerly known as the Ohio State University College of Medicine and Public Health) is the medical school at Ohio State University. It is located in Columbus, Ohio.

Does Ohio State have a hospital on campus?

University Hospital is the flagship patient care facility of The Ohio State University Wexner Medical Center. We are a 900-bed hospital that offers patients the latest in care, research and technology.