Type text, add images, blackout confidential details, add comments, highlights and more.
02. Sign it in a few clicks
Draw your signature, type it, upload its image, or use your mobile device as a signature pad.
03. Share your form with others
Send it via email, link, or fax. You can also download it, export it or print it out.
How to use or fill out Electric Breast Pump Prescription Form - Lehan Drugs with our platform
Ease of Setup
DocHub User Ratings on G2
Ease of Use
DocHub User Ratings on G2
Click ‘Get Form’ to open the Electric Breast Pump Prescription Form in the editor.
Begin by filling out the 'Patient Information' section. Enter the patient's name, date of birth, insurance ID number, and phone number in the designated fields.
Next, move to the 'Prescription Information' section. Here, print the prescriber’s name and NPI number clearly. Ensure accuracy as this information is crucial for processing.
Indicate the equipment needed by selecting 'Double Electric Breast Pump and Replacement Accessories'. Specify the length of need as 12 months.
In the diagnosis field, check 'V24.1 - Breastfeeding/Lactating Mother' or provide an alternative diagnosis if applicable.
Finally, have the prescriber sign and date the form at the bottom. Remember that no stamped or co-signatures are accepted.
Once completed, fax the form to (866) 509-3169 as indicated on the document.
Start using our platform today for free to streamline your document editing and submission process!
Fill out Electric Breast Pump Prescription Form - Lehan Drugs online It's free
You will need a physician prescription to get a pump. Make sure to note that you will not be reimbursed for a pump purchased at a retail store. If you contact a pump supplier directly, they may ask for your doctors name and phone number and the babys due date or the date the baby was delivered.
Does insurance cover an electric pump?
Your health insurance plan must cover the cost of a pump. It may be either a rental unit or a new one youll keep. Your plan may have guidelines on whether the covered pump is manual or electric, the length of the rental, and when youll receive it (before or after birth).
How to get a free electric pump?
If you cant get a pump through Medicaid or you dont have insurance, you may be able to get or rent a pump through WIC. docHub out to your WIC clinic to find out if youre eligible and what other services may be available to you.
Related Searches
Electric Breast pumpsLehan Drugs jobsBreast pump Store insuranceIntegrated home care services Breast PumpBreast pump medical supply storeFree breast pump IllinoisMedela breast pump recyclingThe breast pump
Related links
DOCUMENT RESUME LI 003 875 U.S. Government Films
60 days. Use the order form furnished in the back of this catalog. Additional forms are available on request. The following abbreviations are used in the
This site uses cookies to enhance site navigation and personalize your experience.
By using this site you agree to our use of cookies as described in our Privacy Notice.
You can modify your selections by visiting our Cookie and Advertising Notice.... Read more...Read less
