Order Forms

Renaissance Medical Equipment makes it easy to place your order with us. Below is an order form for each category in PDF format. When finished with the form, you may save it and email it to us or fax it to (866) 565-5190.

Please keep a copy of the order form in your patient's file.


PDF Forms

New Medicare Requirements

You must have documentation of a face to face evaluation before you deliver (or bill for) the following devices:

  • Transcutaneous electrical nerve stimulation (TENS) units;
  • Rollabout chairs;
  • Oxygen and respiratory equipment;
  • Hospital beds and accessories;
  • Cervical traction; or
  • DME, prosthetics, or orthotics billed to CMS for $1,000 or more.

During a recent DME MAC A conference held in Annapolis, MD, CMS representatives stated that suppliers who bill for the aforementioned products may experience denied claims for the following reasons:

  • If there is no face-to-face encounter within 6 months prior to the detailed written order, contractors.
  • If physician completes detailed written order before the face-to-face encounter.
  • If face-to-face documentation does not include information supporting the patient was evaluated/treated for condition supporting DME ordered.
  • If physician does not document occurrence of face-to-face by signing/co-signing and dating pertinent portion of medical record confirming face-to-face conducted by nurse practitioner, physician assistant, or clinical nurse specialist.
  • If detailed written order does not include patient's name, item ordered, prescribing practitioner's NPI, signature of ordering practitioner (physician, PA, NP, or CNS), and the date of the order.