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
         Nebulizers/Accessories
         Oxygen
         Respiratory Assist Device (RAD)
         Tracheostomy Care Supplies
         Suction Pumps
Medical/Surgical Supplies
         Incontinence Appliance/Care Supplies
         Enteral Nutrition
Medical Equipment
         Blood Glucose Monitors/Supplies
         Pressure Reducing Support Services
         Seat Lift Mechanism
Rehabilitation Services and Equipment
         Canes and Crutches
         Commode Chairs
         Power Operated Vehicles
         TENS Units/Supplies
         Walkers
         Patient Lifts
Wheelchairs
         Wheelchair Base/Accessories
Alliance Medical Product list
         Products