Order Forms
Clicking any of the links below will download a PDF copy of the form to your computer. Forms can then be saved, printed, any and all necessary information filled in, and the completed form can then be sent to the provider for billing purposes.
The “Cane/Crutch” order provides D&H with all necessary information to supply the item to the patient and bill the patient’s insurance, when applicable.
Detailed Physicians Order Form
This “detailed physicians order” provides D&H Drug Store with necessary information needed for billing patients insurance for prescribed medical equipment. Occasionally, more information will be needed in order for us to provide certain supplies. In such cases, our medical equipment department will fax additional documents to the prescriber’s office.
The “Hospital Bed” order provides D&H with most of the information needed to supply this item to the patient and bill their insurance. However, due to the numerous and extensive requirements from Medicare for this particular item, our medical equipment staff may need to contact the prescriber’s office for further information.
The “Manual Wheelchair” order provides D&H with most of the information needed to supply this item to the patient and bill their insurance. However, due to the numerous and extensive requirements from Medicare for this particular item, our medical equipment staff may need to contact the prescriber’s office for further information.
The “Support Surface” order provides D&H with most of the information needed to supply this item to the patient and bill their insurance. However, due to the numerous and extensive requirements from Medicare for this particular item, our medical equipment staff may need to contact the prescriber’s office for further information.
Urological and Ostomy Supplies
The “Urological/Ostomy” order provides D&H with most of the information needed to supply this item to the patient and bill their insurance. However, due to the numerous and extensive requirements from Medicare for this particular item, our medical equipment staff may need to contact the prescriber’s office for further information.
The “Walker” order provides D&H with all necessary information to supply the item to the patient and bill the patient’s insurance, when applicable.
The “Wheelchair Cushion” order provides D&H with most of the information needed to supply this item to the patient and bill their insurance. However, due to the numerous and extensive requirements from Medicare for this particular item, our medical equipment staff may need to contact the prescriber’s office for further information.
