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INDIANA HEALTH COVERAGE PROGRAMS PROVIDER REFERENCE MODULEDurable and Home Medical Equipment and SuppliesLIBRARY REFERENCE NUMBER: PROMOD00024 PUBLISHED: MARCH 7, 2018, POLICIES AND PROCEDURES AS
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To fill out the durable and home medical form, follow these steps:
02
Start by providing your personal information, such as your name, address, and contact details.
03
Indicate the type of durable and home medical equipment you are requesting.
04
Specify your medical condition or diagnosis that necessitates the need for this equipment.
05
Include any supporting documents or medical records that might be required.
06
Provide information about your healthcare provider, including their name, contact details, and any prescriptions or recommendations they have provided.
07
Review the form to ensure all the information is accurate and complete.
08
Sign the form and submit it through the designated channel, such as mailing it to the appropriate healthcare department or submitting it online.
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Follow up with the healthcare provider or insurance company to track the progress of your request.
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Be prepared to provide any additional information or documentation if requested during the review process.
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Maintain a copy of the filled-out form and any related correspondence for your records.

Who needs durable and home medical?

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Durable and home medical equipment is needed by individuals who require assistance or support due to a medical condition or impairment. This can include, but is not limited to:
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- Patients recovering from surgery or injury who need mobility aids like wheelchairs or crutches.
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- Individuals with chronic illnesses or disabilities who require devices such as oxygen concentrators, nebulizers, or home dialysis equipment.
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- Seniors or individuals with limited mobility who need assistive devices like grab bars, shower chairs, or walking aids.
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- Patients with respiratory conditions who need respiratory assistive devices like ventilators or CPAP machines.
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- Individuals in need of home healthcare services, such as wound care supplies or home infusion therapy equipment.
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Ultimately, anyone whose medical condition or impairment can be improved or managed with the help of durable and home medical equipment may benefit from using them.
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Durable and home medical refers to medical equipment that is intended for repeated use in the home.
Healthcare providers and suppliers who provide durable and home medical equipment are required to file.
Durable and home medical forms can typically be filled out online or in person with the healthcare provider or supplier.
The purpose of durable and home medical is to provide patients with the equipment they need for home medical care.
Information such as patient demographics, medical diagnosis, prescribed equipment, and duration of use must be reported on durable and home medical forms.
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