Lehans Baby Breast Pump Prescription Form 2016-2025 free printable template
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Lean Breast Pumps1407 South Fourth Street DeKalb, Illinois 60115Phone: 815.758.0911Fax: 866.509.3169www.lehanbreastpumps.combat Pump Prescription Form Patient Information Patient Name: Patient DOB:
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How to fill out Lehans Baby Breast Pump Prescription Form
01
Obtain the Lehans Baby Breast Pump Prescription Form from your healthcare provider or the Lehans website.
02
Fill in your personal information including your name, address, and contact details at the top of the form.
03
Provide your baby's information, such as name, date of birth, and any relevant medical history.
04
Specify the type of breast pump needed (e.g., double electric, manual) as recommended by your healthcare provider.
05
Include the reason for the prescription, whether it’s for medical necessity or to support breastfeeding.
06
Ensure that the prescribing physician's information is completed, including their name, address, and contact number.
07
Sign and date the form at the bottom to authorize the prescription.
Who needs Lehans Baby Breast Pump Prescription Form?
01
Parents or guardians who require breast pump assistance for feeding their infants.
02
Mothers facing challenges with breastfeeding and seeking to express milk.
03
Individuals with medical conditions affecting breastfeeding, needing a breast pump for better milk supply.
04
Caregivers or support systems involved in feeding infants when the mother is unable to breastfeed directly.
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What is Lehans Baby Breast Pump Prescription Form?
Lehans Baby Breast Pump Prescription Form is a document required by healthcare providers to prescribe breast pump equipment for nursing mothers, enabling them to obtain necessary medical supplies covered by insurance.
Who is required to file Lehans Baby Breast Pump Prescription Form?
The form is typically required to be filed by the healthcare provider, such as a doctor or a lactation consultant, who is prescribing the breast pump for the patient.
How to fill out Lehans Baby Breast Pump Prescription Form?
To fill out the form, the healthcare provider must include patient details, specify the medical necessity for a breast pump, and provide any relevant diagnosis codes or notes that support the need for the device.
What is the purpose of Lehans Baby Breast Pump Prescription Form?
The purpose of the form is to document the medical necessity of a breast pump for patients, enabling them to receive the needed equipment through insurance coverage and ensuring proper clinical support.
What information must be reported on Lehans Baby Breast Pump Prescription Form?
The form must include patient identification information, healthcare provider details, specific breast pump type prescribed, medical necessity justification, and any relevant diagnosis or treatment codes.
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