Patient Delivery Receipt - Cardinal Health 2026

1. Click ‘Get Form’ to open the Patient Delivery Receipt in the editor.
2. Begin by filling out the 'Product Delivery Location' section, selecting either 'Facility' or 'Patient Home'.
3. In the 'Patient/Designee Signature' field, ensure that the patient or their designee signs and dates the receipt.
4. Complete the 'Facility Name', 'Facility Address', and patient details including 'Name', 'DOB', and 'Phone #'.
5. Fill in the 'Product Receipt Date' and if applicable, the discharge date from a hospital/facility.
6. Select items from the list provided under 'Description', checking off item numbers and entering quantities as required.
7. Answer questions regarding previous use of a Negative Pressure Wound Pump and provide details on current supplies.
8. Indicate who will be providing care for the patient, filling in any necessary contact information for that provider.
9. Finally, ensure all fields are filled out completely before submitting your form for approval.

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