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Certificate of Medical Necessity DME 484

Certificate of Medical Necessity DME 484

www.cms.gov

Indicate patient’s date of birth (MM/DD/YY) and sex (male or female); height in inches and weight in pounds, if requested. (NPI). If using the NPI Number, indicate this by using the qualifier XX followed by the 10-digit number. If using UPIN number, use the qualifier 1G followed by the 6-digit number. (For example. 1Gxxxxxx)

  Medical, Certificate, Meals, Pound, Necessity, Weight, Certificate of medical necessity, Weight in pounds

Push Up Standards Sit Up Standards 2 Mile Run …

Push Up Standards Sit Up Standards 2 Mile Run …

www.mtu.edu

Table 3–1 Weight for height table (screening table weight) Male weight in pounds, by age Female weight in pounds, by age Height (in Minimum 17–20 21–27 28–39 40+ 17–20 21–27 28–39 40+

  Standards, Meals, Pound, Weight, Height, By age, Male weight in pounds, Weight in pounds, By age height

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Certificate of Medical Necessity, Male, Weight in pounds, Standards, Weight, Height, Male weight in pounds, By age, By age Height