Requirements for submitting foot / ankle prescription
Please include the following:
- Face Sheet / Demographics – For patient (from practice’s EHR / EMR or files). Please fax or attach to DME order.
- Medical Records / Chart Notes (from practice’s EHR / EMR or files). Please fax or attach to DME order.
- Fill out Patient form
- Fill out Physician form
TO DOWNLOAD FORMS
If you want to print our patient or physician forms, please download the forms by clicking on the links below, fill out and fax to (833) 228-3600 or email to Billing@CyteMed.com
If you want to access our patient form digitally, please click on the link below, fill out and submit digitally.