Patient was admitted to a hospital

Patient was bed confined before the ambulance service

Patient was bed confined after the ambulance service

Patient was moved by stretcher

Patient was unconcious or in shock

Patient was transported in an emergency situation

Patient had to be physically restrained

Patient had visible hemorrhaging

Ambulance service was medically necessary

Patient is ambulatory

Ambulation is Impaired and Walking Aid is Used for Therapy or Mobility

Patient is confined to a bed or chair

Patient is Confined to a Room or an Area Without Bathroom Facilities

Ambulation is Impaired and Walking Aid is Used for Mobility

Patient Condition Requires Positioning of the Body or Attachments Which Would Not be Feasible With the Use of an Ordinary Bed

Patient needs a trapeze bar to sit up due to respiratory condition or change body positions for other medical reasons

Patient's Ability to Breathe is Severely Impaired

Patient condition requires frequent and/or immediate changes in body positions

Patient can operate controls

Siderails Are to be Attached to a Hospital Bed Owned by the Beneficiary

Patient owns equipment

Mattress or Siderails are Being Used with Prescribed Hospital Bed Owned by the Beneficiary

Patient Needs Lift to Get In or Out of the Bed or to Assist in Transfer from Bed to Wheelchair

Patient has an orthopedic impairment requiring traction equipment which prevents ambulation during period of use

Item has been prescribed as part of a planned regimen of treatment in patient home

Patient is highly susceptible to decubitus ulcers

Patient or a care-giver has been instructed in use of equipment

Patient has poor diabetic control

A 6-7 hour nocturnal study documents 30 episodes of apnea each lasting more than 10 seconds

Without the equipment, the patient would require surgery

Patient has had a total knee replacement

Patient has intractable lymphedema of the extremities

Patient is in a nursing home

Patient is concious

This feeding is not the only form of nutritional intake for this patient

Patient was administered premix

Oxygen delivery equipment is stationary

Certification signed by the physician is on file at the supplier's office

Patient Has Mobilizing Respiratory Tract Secretions

Patient or Caregiver is Capable of Using the Equipment Without Technical or Professional Supervision

Patient or Caregiver is Unable to Propel or Lift a Standard Weight Wheelchair

Patient Requires Leg Elevation Edema or Body Alignment

Patient Weight or Usage Needs Necessitate a Heavy Duty Wheelchair

Patient Requires Reclining Function of a Wheelchair

Patient is Unable to Operate a Wheelchair Manually

Patient or Caregiver Requires Side Transfer into Wheelchair, Commode or Other