Title xix 2014 form-2025

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The document is a Title XIX Home Health Services Durable Medical Equipment (DME) and Medical Supplies Physician Order Form, which outlines the process for physicians to order necessary medical supplies for clients. It includes sections for client and supplier information, details on requested equipment, diagnosis justification, and physician attestation of medical necessity. The form must be completed accurately and submitted within 90 days of the physician's signature.

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Versions	Form popularity	Fillable & printable
2016	4.8 Satisfied (201 Votes)
2014	4.4 Satisfied (565 Votes)
2013	4.4 Satisfied (492 Votes)

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