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Wheelchair PrecertificationClinical Worksheet Phone: 8004429300 / Fax: 8008483623Patients name: DOB: Member ID: Provider: Phone: Fax: Provider address: Ordering physician: Phone: Fax: Physician address:
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Wheelchair - unicare is a form used to report information about wheelchairs supplied to patients under certain healthcare plans.
Healthcare providers and suppliers who supply wheelchairs to patients are required to file wheelchair - unicare forms.
To fill out wheelchair - unicare, healthcare providers need to provide information about the wheelchair, patient, healthcare plan, and other relevant details.
The purpose of wheelchair - unicare is to track and report the distribution of wheelchairs to patients under specific healthcare plans.
Information such as patient details, wheelchair specifications, healthcare plan information, and dates of wheelchair supply must be reported on wheelchair - unicare.
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