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MEDICAL NECESSITY FORMS Description
Stander Stander or Standing Frame Documentation (Medicaid)
Bath Chair Documentation for Custom Bath Chair or Shower Chair (Medicaid)
Standers, Gait Trainers & Walkers Documentation for Standers, Gait Trainers & Walker (Medicaid)
Specialty Car Seat Documentation for Pediatric Specialty Car Seat
Title 19 Physician Order Form Medicaid Title XIX Physician Order Form eff. 04/2016
Mobility Assessment Form Medicaid Mobility Assessment Form / PT Evaluation Form