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Get and Sign Certificate of Medical Necessity Form for Oxygen

Get and Sign Certificate of Medical Necessity Form for Oxygen

Use a Certificate Of Medical Necessity Form For Oxygen template to make your document workflow more streamlined.

Secondary polycythemia Sleep apnea Other Please continue on the next page. 15-406 12/16 An independent licensee of the Blue Cross Blue Shield Association. Page 1 Stationary oxygen flow rate presribed Lab report attached LPM Results can be confirmed by Related to the question directly above check the appropriate box below During normal activities of daily living walking sitting During exercise therapy hours per day Portable oxygen flow rate presribed if different than stationary flow rate...
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