Thank you for viewing and downloading our qualifying criteria forms! There are two items Insurance companies require for coverage consideration:

  • Standard Written Order (SWO) - A standard form with detailed information
  • Medical Records - Specific information that is needed in a patient's medical records

The SWO and Medical Records outlined below have Medicare requirements - some insurance companies may request more. There may also be deductible and/or co-insurance requirements that will affect payment and customers may always waive their insurance benefits and privately pay.

If you would like more information or if you would like us to prepare patient specific forms please contact us at 651-644-9770.

Group I Support Surfaces

Group II Support Surfaces

Manual Wheelchairs

Hospital Beds


Negative Pressure Wound Therapy


Patient Lift

Positive Airway Pressure Devices

Surgical Dressings