DME Cheat Sheet



Physicians Face To Face Encounter


When ordering any type of Home Health or DME supplies, please make sure to put the above at the top at the top of the note.

Write your Notes as you normally would listing Diagnosis and Drug allergies.



Length of Need: = 99 years Lifetime

Beneficial to Resident


Semi-Electric Hospital Beds:

-The resident requires frequent changes in body position.

-The resident has (insert medical condition) which requires positioning of the body in ways not feasible with an ordinary bed.

-The resident requires the head of the bed to be elevated more than 30 degrees mos of the time due to (insert medical problem or problems with aspiration). Pillows or wedges have been tired with no success.


-The resident has mobility limitation that significantly impairs his/her ability to participate in one or more ADLs in the home and prevents him/her from accomplishing an ADL entirely or within a reasonable amount of time.

-The resident has sufficient upper extremity function and other physical and mental capabilities needed to safely self-propel the manual wheelchair that is provided in the home during a typical day.

-The resident has a caregiver who is available , willing and able to provide assistance with the wheelchair.



-The resident has severe lung disease or hypoxia-related symptoms that might expected to improve with oxygen therapy and

-Pressure Reducing Support Surface (APP/GEL Overlay/Concave Mattress)

-Resident cannot independently make changes in body position significant enough to alleviate pressure.

-Resident has fecal or urinary incontinence.

-Resident has altered sensory perception.

-Resident has compromised circulatory status.

-Resident has one or more pressure ulcer on the trunk or pelvis and more or more of the following conditions:

-Resident has fecal or urinary incontinence.

-Resident has altered sensory perception.

-Resident has compromised circulatory status.


Home Health:



Home Health Skilled Nurse:

-To evaluate and treat open wound on (location)

-To perform in and out cath for UA C & S



-To evaluate and treat gait training and strengthening

to evaluate and treat for increased falls

-Speech Therapy and Occupational Therapy:

To evaluate and treat


In the Plan, List what exactly patient needs: Please be specific

1. SE Hospital Bed with Concave Mattress

2. HH SN to obtain UA C & S by in and out cath

3. HH PT to eval and Treat gait training and strengthening due to abnormal gait etc,

4. HH ST & OT to eval and treat


Homebound Status:

-Resident qualifies for Home Health due to:

-Resident requires one plus assistance to leave facility due to increased fall risk.

-Resident requires 24/7 supervision due to Dementia.

-Resident is unable to leave facility due to becoming SOB after ambulating 20 feet on flat surface.

-Resident is immobile and unable to leave facility.

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