From North Central Oklahoma Ostomy Outlook September 2013:

Documentation your Doctor needs to provide for your Supplies

by James Knight, Knight Medical Supply LLC

These are notes that James Knight handed out during his presentation at our meeting in Stillwater on Aug 19, 2013.

Name:                                                 Date:
ICD-9 Code(s):
Detailed Description of the Item(s):
Item:
      Quantity to be Dispensed:
      Frequency of Use:
      Length of Need:
Item:
      Quantity to be Dispensed:
      Frequency of Use:
      Length of Need:

Physician Name:
Physician Signature:                             Date:

DETAILED WRITTEN ORDERS


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This page last revised 2013-09-17
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