For medical facilities, IPAs & discharge planners

Facility referral & order intake

One form for the whole order — who the patient is, how the equipment is authorized, and exactly what you need. Our intake team confirms the benefit, works the authorization and calls you back with the delivery date.

What to have ready

A signed order or prescription from the ordering physician
The authorization or referral number, if one has already been issued
Patient demographics, insurance member ID and home address
The itemized equipment and supplies you need, with sizes where they matter

Authorizations handled on our side

We hold active contracts with Medicare, Medi-Cal and the managed care plans across Southern California. Send what you have — we chase the authorization, not your staff.

Fax orders & records

Send the order, prescription or medical records to (844) 474-7923. Our intake team picks up incoming faxes and starts the authorization the same business day.

Discharging today? Call (760) 248-1000 and our intake team will pull it forward.

Facility or practice *

Your name *

Your role

Direct line *

Fax (for orders and authorization)

Patient information

Patient name *

Date of birth

Patient or caregiver phone

Home address

Insurance & authorization

Insurance plan

Plan type

Member / subscriber ID

Authorization number

Authorization status

How soon is it needed?

Ordering physician

Physician NPI

Equipment & supplies needed

Item 1

Item or supply *

HCPCS (if known)

Qty

Size, diagnosis or notes for this item

Delivery address (if different from the home address)

Diagnosis, documentation or delivery notes

Patient information is visible only to our intake staff and is used solely to verify coverage and fulfill the order. Please send the minimum needed — we'll request records and identifiers securely after we call you back.