Alabama Wheelchair Specialists
Monday, September 06, 2010
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Forms
Here are some forms that you can print for personal use:
Intake form.doc
Home assessment.doc
Privacy practices.doc
Complaint notification.doc
Physician detailed written order.doc
Physician face to face evaluation.doc
Letter of medical necessity and chart notes.doc
Alabama Medicaid Referral Form-362.pdf
Alabama Medicaid Prior Authorization for adult motorized wheelchair.pdf
Feel free to fax any of these to us at
(205) 322-3253
. Questions? Call
(205) 322-3250
.