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Phoenix, AZ 85009 4178  Form

Phoenix, AZ 85009 4178 Form

Use a wheelchair prescription form 0 template to make your document workflow more streamlined.

An arm height that is different than that available using non-adjustable arms and the patient spends at least 2 hours per day inthe wheelchair. 301 N. 37th Dr. Suite 101 Phoenix AZ 85009-4178 p 602-272-0778 f 602-272-0646 Medicare requires the following documentation for prescribing Manual Wheelchairs Patient Information Patient Name Address City State Zip Telephone D. 2 Why mobility limitations cannot be resolved with a walker. 3 How the use of wheelchair will improve mobility and that the...
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