Professionals Test

Let us know how we are doing!

We truly value your input. Follow the link below to take a short survey about your experience with Fort Medical Equipment. We use your input to make our service stronger.

Referral Feedback Survey

What information do I need to send with my referral?

  • Patient demographic information, including insurance information
  • Height and weight to ensure equipment can be fitted properly
  • History and physical from the medical record
  • Progress notes indicating medical necessity for prescribed medical equipment
  • For respiratory equipment, we will need respiratory settings (e.g., Oxygen 2 lpm continous via nasal cannula)
  • Physician information

How do I send a referral?
Fax: 872-469-1691
Telephone: 920-568-9860

What is the turnaround time for a referral?
We will contact the patient to schedule delivery within 48 hours, pending complete information, including signed orders.

Medicare Face-to-Face Requirements

On July 1, 2013, section 6407 of the Affordable Care Act established operational protocols necessary to comply with face-to-face encounter requirements for certain DME items. The law states that:

  • A patient encounter must occur within six months prior to the order being written for DME.
  • A physician, nurse practitioner, physician assistant or clinical nurse specialist must have a face-to-face encounter with the patient.
  • If the face-to-face encounter has occurred within six months and is completed by a physician assistant, nurse practitioner, or clinical nurse specialist, the physician must cosign and date the pertinent portion of the face-to-face encounter.

What must be documented in the face-to-face encounter?
Beneficiary was evaluated and/or treated for a condition that supports the DME ordered.

Written Order Prior to Delivery

What must be on the written order prior to delivery?

  • The beneficiary’s name
  • DME item(s) being ordered
  • The prescribing practitioner’s National Provider Identifier (NPI)
  • The signature of the ordering practitioner
  • The date of the order

What DME items require a face-to-face and a written order prior to delivery?

  • Bilevel positive airway pressure
  • CPAP
  • Cough assist
  • Hospital beds
  • Nebulizer
  • Oscillatory devices
  • Oxygen
  • Seat lift
  • TENS
  • Traction devices
  • Ventilator
  • Wheelchairs and accessories

Who can sign a written order prior to delivery?

  • Physician
  • Nurse Practitioner
  • Physician Assistant
  • Clinical Nurse Specialist
  • Any of the above can sign the written order prior to delivery as long as that provider has a NPI and is enrolled in PECOS

What is PECOS?

PECOS stands for Provider Enrollment, Chain and Ownership System.

PECOS is a way for health care providers to modify their provider file online. It is designed to check the provider credentials before Medicare claims are paid.

Click here for more information on PECOS


Which delivery options are available?

  • Home delivery
  • UPS
  • In-store pick up
Detailed Written Orders for Printing

For other equipment forms, please contact our office at 920.568.9860.

Other Forms