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Walgreens cmn form for diabetic supplies pdf

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The document is a DME Information Form (CMS-10125) for External Infusion Pumps, issued by the Department of Health and Human Services' Centers for Medicare & Medicaid Services. It outlines the necessary information required for certification, including patient and supplier details, procedure codes, and clinical information related to the use of infusion pumps. The form also includes instructions for completion and emphasizes the importance of accurate information to avoid legal liabilities.

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