Physician Progress Note Page 3

ADVERTISEMENT

pelvis. also include a skin assessment as well as a statement of location and size of pressure ulcer(s). Group 1I
Support Surfaces form completed with physician signature, NPI #, and date is required.
Alternating Pressure Pad and Pump (APPNP)
I evaluated my patient face to face for durable medical equipment. Patient needs an alternating pressure pad
and pump due to stage I or II pressure ulser(s) located on the trunk or pelvis.
Group 1 Support Surfaces form completed with physician signature, NPI #, and date is required.
Hoyer Lift
Without the use of the lift the patient would be confined to a bed.
PLEASE NOTE:
We recommend the above verbiage be part of a standard progress note in the format commonly used by the
physician or facility. Use some of your own words to make each order specific to each patients need for the
equipment. Each sentence has the verbiage required by Medicare. Use the patients name instead of “patient”.
If this is a separate request, to ensure the equipment is approved add additional medical reasons the patient
needs the equipment specific to this patient. The following are required by Medicare as well:
Date:
MRN: (medical record number)
Patient:
Physician:
Signed by:
Physician ____ Date ______
Printed physicians name
NPI # ____
Written by
acting as scribe for
.
If progress notes is written by an employee of Dr or facility.

ADVERTISEMENT

00 votes

Related Articles

Related forms

Related Categories

Parent category: Medical
Go
Page of 4