ADMISSION INFORMATION REQUIRED

When you call Alliance Medical, Inc., please have the following information available:

> Patient Name
> Patient Address
> Patient Phone (Home/Work)
> Date of Birth
> Social Security Number
> Physician Name
> Physician Phone
> Emergency Contact Person
> Emergency Contact Phone
> Diagnosis
> Height/Weight
> Insurance Carrier(s)
> Insurance Policy Numbers
> Insurance Carrier Phone Numbers

All Medical Equipment and Supplies are covered under Medicare Part B, which only pays 80% of the Medicare allowable for any covered item. If a patient has a secondary insurance it may pick up the remaining 20%. 

This is for informational purposes only and not all inclusive of current DMERC Region’s DMEPOS Supplier Manual and bulletins/advisories.

TABLE OF CONTENTS

BEDS:

          Fixed Height Hospital Bed

          Variable Height Hospital Bed

          Semi-Electric Hospital Bed

          Total Electric Hospital Bed

          Trapeze Bars

RESPIRATORY CARE EQUIPMENT:

          CPAP/BiPAP

          Nebulizers & Accessories

          Oxygen

          Respiratory Assist Device (RAD)

          Tracheostomy Care Supplies

          Suction Pumps

MEDICAL/SURGICAL SUPPLIES:

          Incontience Appliance/Care Supplies

          Enteral Nutrition

MEDICAL EQUIPMENT:

          Blood Glucose Monitors & Supplies

          Pressure Reducing Support Services

          Seat Lift Mechanisms

REHABILITATION SERVICES/EQUIPMENT:

          Canes & Crutches

          Commode Chairs

          Power Operated Vehicles

          TENS Units &Supplies

          Walkers

          Patient Lifts

WHEELCHAIRS:

           Wheelchair Base & Accessories