Professional Referral Helpline

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Referral

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DETAILED WRITTEN ORDERS PRIOR TO DELIVERY (DWOPD)

(MUST HAVE)

  • Beneficiary's name
  • The date of the order
  • Start date of the order (if different than the date of the order)
  • Detailed description of the items (i.e. semi-electric hospital bed) to include:
  • Dosage/concentration if applicable
  • Route of administration if applicable
  • Frequency of use if applicable
  • Quantity to be dispensed if applicable
  • Number of refills if applicable
  • Diagnosis
  • Physician signature and date
  • Physician NPI

NOTE: Physician Notes must address the need of the equipment