Dme request form - Orbit Medical 2025

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The document is a DME (Durable Medical Equipment) request form for Orbit Medical, requiring detailed account and patient information to process equipment orders efficiently. It includes sections for equipment requests, patient demographics, delivery details, and physician information, along with confidentiality notices.

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Click ‘Get Form’ to open the dme request form in the editor.
Begin by filling out the Account Information section. Enter your account name, contact person, phone number, and fax number. This ensures that Orbit Medical can reach you for any clarifications.
In the Equipment Request section, select the items needed by checking the appropriate boxes. Options include manual wheelchairs, oxygen supplies, hospital beds, and more. Be sure to specify any other equipment required in the provided space.
Complete the Patient Information section by entering the patient's name, height, and weight. These details are crucial for processing your request accurately.
Fill in the Delivery Info section with a contact person for delivery and their phone number. Also, provide a complete delivery address to ensure timely arrival of equipment.
Indicate whether the patient is discharging by selecting 'YES' or 'NO'. If yes, provide the discharge date and facility information.
Finally, ensure all required fields marked with an asterisk (*) are completed before submitting your form.

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Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

What is orbit healthcare?

Orbit Healthcare is the industry leader in AI-Powered, virtual and point of care insurance capture, extraction, verification, prior authorization and document AI. Our solutions reduce denials and increase eligibility verification accuracy with automated data intake and processing in real time.

What is orbit in health?

(OR-bit) The space within the skull that contains the eye, including its nerves and muscles. The orbit also includes the eyelids and the glands that make tears. It is made up of seven bones that surround and protect the eye. Also called eye socket.

Who is the CEO of orbit medical?

August 2023, MINNEAPOLIS Reliable Medical is re-aligning its leadership and moving Brandon Bliss, former CEO of Orbit Medical, which it acquired in December 2022, into an executive vice president role, where he will oversee growth and operations for all divisions. . Under Brandons direction, we expect continued

Who is orbit medical?

Orbit Medical is one of the leading providers of specialty wheelchairs, in-home oxygen system, hospital beds and orthopedic bracing in the United States.

What is the fax number for orbit medical?

Submit a referral via fax: Fax the filled out form along with the patients face sheet and most recent chart notes to 800-430-0255.

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Who is the CEO of reliable medical?

Charles Sargeant, who was previously Reliable Medicals COO and who has more than 20 years of experience at National Seating Mobility and Apria Healthcare, was named CEO this summer, replacing Katie Stevens, who is now the companys chief people officer.