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PHONE: 1.888.248.1975 FAX: 1.888.248.2026 EMAIL: connect chcsolutions.com CONTINUUM CONNECT WHEELCHAIR ORDER FORM **Please attach face sheet w/ patient demographics & insurance info**PATIENT INFORMATION
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How to fill out continuum connect wheelchair order
How to fill out continuum connect wheelchair order
01
To fill out the Continuum Connect wheelchair order, follow these steps:
02
Start by gathering all the necessary information about the wheelchair user, such as their personal details, medical history, and specific needs.
03
Begin the order by inputting the user's basic information, including their name, contact details, and any identification numbers.
04
Proceed to enter the user's medical information, such as their diagnosis, current condition, and any prescribed treatments or medications.
05
Specify the wheelchair requirements, including the type of wheelchair needed, any customization options, and any specific accessories or add-ons required.
06
Provide detailed information about the user's body measurements, including height, weight, and any specific anatomical considerations.
07
Include any additional information or special requests in the designated section of the order form.
08
Double-check all the entered information for accuracy and completeness.
09
Submit the completed Continuum Connect wheelchair order form.
10
Await confirmation and further instructions from the relevant wheelchair provider or healthcare professional.
11
Keep a copy of the order form for future reference and documentation.
Who needs continuum connect wheelchair order?
01
The Continuum Connect wheelchair order is needed by individuals who require a customized wheelchair for their mobility needs.
02
This may include individuals with physical disabilities, elderly individuals with limited mobility, or individuals recovering from injuries or surgeries.
03
The order is typically initiated and completed by healthcare professionals, therapists, or caregivers who are responsible for coordinating wheelchair provision for their patients or loved ones.
04
It is essential for those in need of a wheelchair to accurately complete the order form to ensure the provision of a suitable and appropriate mobility device.
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What is continuum connect wheelchair order?
Continuum Connect Wheelchair Order is a form used to request a wheelchair for a patient who needs one for mobility purposes.
Who is required to file continuum connect wheelchair order?
A healthcare provider or physician is required to file the Continuum Connect Wheelchair Order.
How to fill out continuum connect wheelchair order?
To fill out the Continuum Connect Wheelchair Order, the healthcare provider must provide the patient's information, medical diagnosis, and specific wheelchair requirements.
What is the purpose of continuum connect wheelchair order?
The purpose of the Continuum Connect Wheelchair Order is to ensure that patients in need of a wheelchair receive the appropriate equipment.
What information must be reported on continuum connect wheelchair order?
The Continuum Connect Wheelchair Order must include the patient's name, medical diagnosis, requested wheelchair type, and any additional instructions.
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