Nebulizer Forms

Purchase Agreement Form | Use to dispense stock and bill respiratory equipment in CT, ME, and NH

Respiratory Delivery Ticket | Delivery Ticket for when dispensing a product in-office to a patient

 

Reference Sheets

ICD-10 Diagnosis Reference Guide | List of commonly used ICD-10 numeric diagnosis codes

Insurance Reference Guide |  List of in-network insurances (and if authorization is required)

Masshealth Prescription Regulation | List of what is required  on a prescription by MassHealth

Face to Face Requirement | Patient Encounter/Face to Face note requirement for nebulizers

Customer Information Guide| Reference sheet for your patient when dispensing a nebulizer