For your convenience, you will find our detailed order forms below. If you need assistance or additional information, our customer service team is just a phone call away and ready to help.
Medicaid Certificate of Medical Necessity
Durable Medical Equipment
- Bathroom Aids
- Bathroom Aids Documentation Requirements
- Breast Pump
- Cane & Crutches
- Cane & Crutches Documentation Requirements
- Group I Support Surface
- Group I Support Surface Documentation Requirements
- Group II Support Surface
- Group II Support Surface Documentation Requirements
- Hospital Bed & Trapeze
- Hospital Bed and Accessories Documentation Requirements
- Lift Chair
- Patient Lift
- Patient Lift Documentation Requirements
- Walker
- Walker Documentation Requirements
- Wheelchair
- Wheelchair Documentation Requirements
Medical Supplies
- Continuous Glucose Monitor (CGM)
- Continuous Glucose Monitor (CGM) Documentation Requirements
- Enteral Nutrition
- Enteral Nutrition (Oral) Documentation Requirements
- Enteral Nutriton (Tube Fed & Feeding Pump) Documentation Requirements
- Medicaid CMN for Enteral Nutrition
- Medicaid CMN for Incontinence
- Ostomy Supplies (Fairbanks location only)
- Ostomy Supplies (Fairbanks location only) Documentation Requirements
- Urological Supplies
- Urological Supplies Documentation Requirements
- Wound Supply
Respiratory Equipment
- Aerosol System/Tracheostomy Care Supplies
- Aerosol System/Tracheostomy Care Supplies Documentation Requirements
- Afflovest (High Frequency Chest Wall Oscillation Device)
- Afflovest (High Frequency Chest Wall Oscillation Device) Documentation Requirements
- Conserving Devices
- Cough Stimulating Device
- Cough Stimulating Device Documentation Requirements
- CPAP/BIPAP
- CPAP/BiPAP for OSA Documentation Requirements
- CPAP/BIPAP Resupplies
- Invasive Ventilator
- Invasive Ventilator Documentation Requirements
- Nebulizer
- Nebulizer Documentation Requirements
- Non-Invasive Ventilation
- Non-Invasive Ventilator Documentation Requirements
- Overnight Oximetry
- Oxygen
- Oxygen Documentation & Testing Requirements
- Pulse Oximeter
- Suction Machine
- Suction Machine Documentation Requirements
Documentation Requirements
- Aerosol System/Tracheostomy Care Supplies
- Afflovest (High Frequency Chest Wall Osciallation Device)
- Ambulatory Aids
- Breast Pump Coverage Criteria
- Continuous Glucose Monitoring
- Cough Stimulating Device
- CPAP/BiPAP for OSA
- Enteral Nutrition (Oral)
- Enteral Nutrition (Tube Fed & Feeding Pump)
- Group I Support Surface
- Group II Support Surface
- Hospital Bed & Accessories
- Incontinence Supplies
- Invasive/Non-Invasive Ventilation
- Lift Chair Coverage Criteria
- Manual Wheelchairs
- Nebulizer
- Ostomy Supplies
- Oxygen Documentation & Testing Requirements
- Oxygen with OSA
- Patient Lift
- Respiratory Assisted Device (RAD)
- Suction Machine
- Urological Supplies
- Wheelchair Seating Coverage Criteria