Form HFS3701K Power Mobility Devices and Custom Manual Wheelchairs Physician's Form - Illinois

What Is Form HFS3701K?

This is a legal form that was released by the Illinois Department of Healthcare and Family Services - a government authority operating within Illinois. As of today, no separate filing guidelines for the form are provided by the issuing department.

FAQ

Q: What is the HFS3701K Power Mobility Devices and Custom Manual Wheelchairs Physician's Form?
A: The HFS3701K form is a medical form used in Illinois for power mobility devices and custom manual wheelchairs.

Q: Who uses the HFS3701K form?
A: Physicians use the HFS3701K form to prescribe power mobility devices and custom manual wheelchairs for their patients.

Q: What information is required on the HFS3701K form?
A: The form requires the patient's personal information, medical diagnosis, justification for the power mobility device or custom manual wheelchair, and the physician's signature.

Q: Do I need to fill out the HFS3701K form for every power mobility device or custom manual wheelchair?
A: Yes, a separate form is required for each power mobility device or custom manual wheelchair.

Q: Can I submit the HFS3701K form electronically?
A: Yes, the HFS3701K form can be submitted electronically as long as it complies with the requirements set by the Illinois Department of Healthcare and Family Services.

Q: Is there a cost associated with filling out the HFS3701K form?
A: There is no cost to fill out the HFS3701K form.

Q: What is the purpose of the HFS3701K form?
A: The purpose of the form is to ensure that power mobility devices and custom manual wheelchairs are prescribed only when medically necessary.

Q: Can I appeal if my request for a power mobility device or custom manual wheelchair is denied?
A: Yes, you have the right to appeal the denial of a power mobility device or custom manual wheelchair.

Q: Are there any specific guidelines for completing the HFS3701K form?
A: Yes, the Illinois Department of Healthcare and Family Services provides guidelines for completing the HFS3701K form.

Q: How long does it take to process the HFS3701K form?
A: The processing time for the HFS3701K form may vary, but it typically takes several weeks.

Q: Can I use the HFS3701K form for power mobility devices and custom manual wheelchairs in other states?
A: The HFS3701K form is specific to Illinois, so you will need to check with the respective state's healthcare department for the appropriate form.

Q: Is the HFS3701K form available in languages other than English?
A: The HFS3701K form is primarily available in English, but translation services may be available upon request.

Q: What should I do if I have additional questions about the HFS3701K form?
A: If you have additional questions about the HFS3701K form, you should contact the Illinois Department of Healthcare and Family Services or consult with your healthcare provider.