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Name: Fillable Online Continuous Passive Motion (CPM) Device for Use on Lower Extremity Fax Email Print - pdfFiller
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This form is required for the continued authorization of a Continuous Passive Motion Device for lower extremity use. It includes sections for patient details, diagnosis, surgery information, and range

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How to fill out continuous passive motion device

How to fill out Continuous Passive Motion Device Authorization Form

01

Obtain the Continuous Passive Motion Device Authorization Form from your healthcare provider or the relevant authority.

02

Fill in your personal information, including your name, address, and contact details.

03

Provide information about the medical condition that requires the use of the Continuous Passive Motion device.

04

Include details about your healthcare provider, such as their name, address, and contact information.

05

Indicate the specific type of Continuous Passive Motion device required.

06

Attach any required medical documentation or prescriptions from your healthcare provider.

07

Sign and date the form to certify that the information provided is accurate.

08

Submit the completed form to the designated authority or insurance company for review.

Who needs Continuous Passive Motion Device Authorization Form?

01

Patients recovering from orthopedic surgeries, such as knee or shoulder surgery.

02

Individuals with conditions that limit joint mobility and require rehabilitation.

03

Patients prescribed the device by their healthcare provider for post-operative care.

04

Individuals seeking insurance coverage for the cost of the Continuous Passive Motion device.

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What is Continuous Passive Motion Device Authorization Form?

The Continuous Passive Motion Device Authorization Form is a document required for the approval and use of continuous passive motion devices, which are used in rehabilitation settings to assist patients in recovering from surgery or injury.

Who is required to file Continuous Passive Motion Device Authorization Form?

Healthcare providers and facilities that intend to use continuous passive motion devices for patient treatment are required to file the Continuous Passive Motion Device Authorization Form.

How to fill out Continuous Passive Motion Device Authorization Form?

To fill out the Continuous Passive Motion Device Authorization Form, the applicant must provide details such as patient information, the type of device to be used, the duration of usage, and any relevant medical history or prescriptions from healthcare professionals.

What is the purpose of Continuous Passive Motion Device Authorization Form?

The purpose of the Continuous Passive Motion Device Authorization Form is to ensure that the use of such devices is medically justified, documented, and evaluated for safety and efficacy in patient rehabilitation.

What information must be reported on Continuous Passive Motion Device Authorization Form?

The information that must be reported on the Continuous Passive Motion Device Authorization Form includes patient name, medical record number, healthcare provider details, description of the device, treatment plan, and any applicable insurance information.

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