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Download Document Files  |
| Care Plans and Follow-ups | |
| Respiratory Equipment Follow up | |  |  |
| Ventilator Care Plan | | | |
| Patient Visit Report | | | |
| Patient Visit Letter | | | |
| Missed Your Visit Letter | | | |
| Miscellaneous Plan of Care (page 1) | | | |
| Miscellaneous Plan of Care (page 2) | | | |
| Plan of Care - Resp & CPAP Equip | | | |
| Plan of Care - Unit Dose Medication (page 1) | | | |
| Plan of Care - Unit Dose Medication (page 2) | | | |
| Care Plan - Oxygen | | | |
| Care Plan - Enteral | | | |
| Care Plan - Apnea Monitor | | | |
| Follow up form | | | |
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| Compliance | |
| Basic Home Safety | | | |
| Emergency Preparedness | | | |
| Sample Oxygen Supplier Priority Account Letter | | | |
| Facility Loss Preparedness Plan | | | |
| Complaint Form | | | |
| Patient Satisfaction Survey | | | |
| Warranty Information Form (addresses supplier standard #6) | | | |
| Complaint Log Sheet (addresses supplier standard #20) | | | |
| Billable & Comp Checklist | | | |
| Notice of Possible Medicare Denial | | | |
| Waiver of Liability | | | |
| MSDS Carbon Dioxide | | | |
| Customer Satisfaction Survey | | | |
| ABN | | | |
| Complaint Resolution Protocol (addresses supplier standard #19) | | | |
| Beneficiary`s Acknowledgement and Agreement to Pay | | | |
| DME/HME Checklist for New & Current VGM Members | | | |
| Medicare Waiver of Liability Form | | | |
| 2006 Federal Poverty Guidelines | | | |
| Medicare Physician Documentation Letter - PAP | | | |
| Medicare Physician Documentation Letter - DMEPOS | | | |
| Medicare Physician Documentation Letter - PMD | | | |
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| Delivery and Pick Up | |
| Pick-Up Ticket - Full Page | | | |
| After Hours Delivery | | | |
| Delivery/Return Ticket | | | |
| Special Delivery | | | |
| Pick-Up Ticket - Half Page | | | |
| Delivery/Pickup Ticket | | | |
| Delivery Ticket | | | |
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| Insurance Forms | |
| Application for Medicare Co-Insurance Waiver | | | |
| Beneficiary`s Acknowledgement | | | |
| Co-Insurance Waiver | | | |
| Reasonable & Necessary Equipment | | | |
| Supplier`s Notice | | | |
| Waiver of Co-Pay Responsibility | | | |
| Waiver of Liability | | | |
| Workman`s Comp | | | |
| Co-Insurance | | | |
| Acknowledgement of Responsibility | | | |
| Private Insurance Information | | | |
| Medicare Denial | | | |
| DME Insurance Verification | | | |
| Billable & Comp Checklist | | | |
| Primary Insurance | | | |
| Secondary Insurance | | | |
| Application for Medicare Co-Insurance Waiver | | | |
| Medicare Waiver of Liability Form | | | |
| Medicare Enrollment Application | | | |
| Assignment of Benefits (AOB) | | | |
| Sample Patient Mobility Prescription | | | |
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| Invoices and Simple Statements | |
| Statement before insurance payment rcvd | | | |
| Invoice without Labor calculations | | | |
| Blank Invoice - Half Page | | | |
| Invoice for Equipment and Oxygen Rental (page 1) | | | |
| Simple Statement | | | |
| Invoice with Labor calculations | | | |
| Blank Invoice - Full Page | | | |
| Invoice Receipt Verification Log | | | |
| Invoice for Equipment and Oxygen Rental (page 2) | | | |
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| Job Descriptions | |
| Safety & Infection Control Officer | | | |
| All Descriptions (zip file) | |
| Account Billing Clerk | | | |
| Accounts Receivable | | | |
| Account Representative | | | |
| Accounts Receivable Manager | | | |
| Accounting Clerk | | | |
| Accounting Manager | | | |
| Accounts Receivable Clerk | | | |
| Billing Clerk | | | |
| Billing Clerk 2 | | | |
| Billing Clerk 3 | | | |
| Billing Supervisor | | | |
| Branch Manager | | | |
| Clean Equipment Technician | | | |
| Cleaner | | | |
| Clerical Billing Assistant | | | |
| Clinical Equipment Technician | | | |
| Clinical Service Support Staff | | | |
| CMN Specialist | | | |
| Compliance Technician/Customer Service Position | | | |
| Confirmation Clerk | | | |
| Contracted Services | | | |
| Customer Service Manager | | | |
| Customer Service Representative | | | |
| Customer Service Representative Order Entry | | | |
| Deliver Equipment Technician | | | |
| Director of Clinical Services | | | |
| Driver | | | |
| Equipment Repair Technician | | | |
| Executive Director | | | |
| Facilities Coordinator Maintenance | | | |
| File Clerk | | | |
| Information Gathering | | | |
| Information Systems Coordinator | | | |
| Inventory Analyst | | | |
| Inventory Clerk | | | |
| Marketing Director | | | |
| Marketing Representative | | | |
| Materials Manager | | | |
| Office Assistant | | | |
| Office Manager | | | |
| Prodution Manager | | | |
| Reception/Administration Assistant | | | |
| Rehab Specialist | | | |
| RehabTechnician | | | |
| Retail Store Manager | | | |
| Sales Manager | | | |
| Sales Representative 1 | | | |
| Sales Representative 2 | | | |
| Service Technician | | | |
| Shipping Receiving Clerk | | | |
| Warehouse Manager | | | |
| Warehouse Manager 2 | | | |
| Respiratory Therapist | | | |
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| Legal Documents | |
| Customer Information | | | |
| Living Wills Explanation Sheet | | | |
| Terms and Conditions of Rental or Sales of Medical Equipment/Supplies | | | |
| Priority Power Restoration | | | |
| Emergency Medical Services Letter | | | |
| Telephone Company Letter | | | |
| CMS Medicare DMEPOS Supplier Standards | | | |
| Revised Federal Poverty Income Limits: March 1, 2002 | | | |
| Financial Hardship Waiver | | | |
| Injury Recording Forms | | | |
| OSHA Injury and Illness Decision Tree | | | |
| Application for Medicare Co-Insurance Waiver | | | |
| Loaner Equipment Agreement & Waiver of Liability | | | |
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| Miscellaneous Logs and Instructions | |
| On-Call Log | | | |
| Daily Activity Log | | | |
| Call Sheet | | | |
| Company Owned Vehicles (page 1) | | | |
| Company Owned Vehicles (page 2) | | | |
| Daily Vehicle Log | | | |
| Delivery Vehicle Stock | | | |
| Supplies/Tools Received | | | |
| Equipment Shipping Log (page 1) | | | |
| Equipment Shipping Log (page 2) | | | |
| "Things To Do Today" Grid | | | |
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| Patient Forms and Checklists | |
| Billing Check Off List | | | |
| MSDS Carbon Dioxide | | | |
| MSDS Cryogenic Liquid Oxygen | | | |
| Liquid Oxygen Orientation | | | |
| Orientacion Oxigeno Liquido | | | |
| Oxygen Concentrator | | | |
| Back-up Hours Existing in Tank | | | |
| Oxygen System - Concentrator | | | |
| Oxygen Orientation Checklist | | | |
| Oxygen/Nebulization Orientation Checklist | | | |
| Oxygen General Checklist | | | |
| Oxygen Concentrator Checklist | | | |
| Batch Quality Control Log | | | |
| Apnea Monitor Training Report | | | |
| Orientation Checklist for Apnea Monitors | | | |
| Placement of BiPAP, BiPAP S/T, or CPAP | | | |
| Suction Machine | | | |
| Suction Pumps | | | |
| Suction Equipment | | | |
| Suction Machine | | | |
| Chest Percussor | | | |
| Pneumogram/Event Recording Checklist | | | |
| Oximeter with Printer Checklist | | | |
| Nebulizer/Compressor Therapy Instructions | | | |
| Patient Monitoring during Treatments | | | |
| Patient Nebulizer Instructions | | | |
| Nebulizer Checklist | | | |
| Rental, Return, & Exchange Invoices | | | |
| Detailed blank equipment checklist | | | |
| Medical Equipment Checklist | | | |
| Document of Patient Teaching | | | |
| Medical Orientation Checklist | | | |
| Commodes and Related Equipment | | | |
| Bathroom Safety Accessories | | | |
| Walker, Cane (Quad) and Commode Seat Orientation | | | |
| Hospital Beds (Electric and Manual) | | | |
| Patient Checklist - Hospital Beds | | | |
| Low Air Loss Bed/Mattress | | | |
| Hydraulic Patient Lift | | | |
| Trapeze Orientation Checklist | | | |
| Trapeze Bars Checklist | | | |
| Traction Equipment Checklist | | | |
| Wheelchair Educational Checklist | | | |
| Walkaid Educational Checklist | | | |
| Walker, Cane (Quad) and Commode Seat Orientation | | | |
| TENS Unit User Guide | | | |
| Blood Glucose Monitors | | | |
| Peak Flow Meters | | | |
| PEP Home Bili Light Checklist | | | |
| Phototherapy Lights | | | |
| Incentive Spirometer | | | |
| MSDS Air | | | |
| MSDS Helium | | | |
| MSDS Nitrous Oxide | | | |
| MSDS Oxygen | | | |
| Apnea Monitor Training Report | | | |
| Clinical Checklist | | | |
| CPAP Therapy | | | |
| Home Ventilator Instructions | | | |
| Hospital Bed Intake Form | | | |
| Oxygen Concentrator Use Guide | | | |
| SVN Intake Log | | | |
| Ventilator Training | | | |
| Wheelchair Intake Form | | | |
| Order Intake - Initial Assessment | | | |
| Informed Refusal Form | | | |
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| Patient Information | |
| Patient Information | | | |
| Patient/Client Bill of Rights | | | |
| Patient Profile Information | | | |
| Customer Worksheet | | | |
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| Payment Plans | |
| Payment Plan for Balance Remaining | | | |
| Payment Plan for Equipment | | | |
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| Personnel/Employment | |
| Application | | | |
| Hourly Time Sheet | | | |
| Personnel Policy and Practice | | | |
| New Employee Orientation | | | |
| Patient Confidentiality | | | |
| Hepatitis B Vaccine Statement | | | |
| Computer Password | | | |
| Sexual Harassment Statement | | | |
| Final Paycheck Deduction | | | |
| Alarm Code | | | |
| Coach Counsel | | | |
| Receipt of Compliance Policy | | | |
| Personnel Action Form | | | |
| Acknowledgment | | | |
| Employee Review Survey | | | |
| Workshop Attendance Evaluation | | | |
| Employee Information Sheet | | | |
| Contract Labor | | | |
| Vacation/Sick Benefits | | | |
| Request for Medical Leave | | | |
| Medical Statement | | | |
| Physician`s Statement of Disability | | | |
| Physician`s Release to Work | | | |
| Accident Report Form | | | |
| Employee Evaluation | | | |
| Performance Improvement Record | | | |
| Employee Disciplinary Notice | | | |
| Continuation of Insurance | | | |
| Employment Status Release | | | |
| Team Questionnaire | | | |
| Plus Delta | | | |
| Action Plan Worksheet | | | |
| Motivators | | | |
| Time Management Log | | | |
| Non-Compete Agreement | | | |
| Disciplinary Issues Report | | | |
| Job Performance Issues Worksheet | | | |
| Recognizing the Troubled Employee in the Workplace | | | |
| Supervisor Intervention | | | |
| Training Needs Assessment | | | |
| Suicide/Depression Risk Questionnaire | | | |
| Drug Free Workplace Policy | | | |
| New Form I-9 | | | |
| Employee Agreement - Consent To Drug Alcohol Test | | | |
| New Form W-9 | | | |
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| Purchase Orders | |
| Equipment Purchase Certification | | | |
| Purchase Requisition - Policy and Procedure | | | |
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| Rent/Purchase Agreements | |
| Rent/Purchase Agreement 1 | | | |
| Rent/Purchase Agreement 2 | | | |
| Rental with Service Agreement | | | |
| Rent/Purchase Invoice | | | |
| Option to Purchase Agreement | | | |
| Supplier Notice to Medicare Beneficiaries in Nursing Homes | | | |
| First Month Purchase Option for Electric Wheelchairs | | | |
| Explanation Capped Rental | | | |
| Explanation Capped Rental Version 2 | | | |
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| Returns and Exchanges | |
| Product Return | | | |
| Equipment Rental Checklist | | | |
| Return for Refund | | | |
| Refund | | | |
| Equipment Exchange, Loan, Repair, Return | | | |
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| Work Orders | |
| Work Order with vehicle information (page 1) | | | |
| Simple Work Order | | | |
| Intake Form | | | |
| Work Order with vehicle information (page 2) | | | |
| Special Order Request | | | |
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| Template Letters | |
| Oxygen Patient 5-Year Letter | | | |
| MIPPA O2 Cap Letter to Congress | | | |
| Oxygen Letter to Patients MIPPA Cap | | | |
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