How to Request Complex DME, such as:
- Manual wheelchairs
- Transport wheelchairs
- Power wheelchairs
- Power scooters
- Home hospital beds
- Mechanical lifts
- Knee scooters
- Overbed table
- Trapeze bar
To request the above items, a Complex Request Form must be completed. This form has 3 parts: Part A, B, and C.
Part A should be completed by the Requestor – the person requesting the equipment.
Parts B and C must be completed by a Healthcare Professional treating the Beneficiary of the equipment.
Complete a Complex Request Form using one of the 2 options below.
Option 1: Request Complex DME Online
Note: The healthcare provider may complete their portion of the form either online or via hard copy. You will select one of these options when completing the online form within OneStop.
Step 1: Click the link below to be directed to Maryland OneStop.
Step 2: Create an account by entering your name and email, then create a password.
Step 3: Verify your email. Check your email - you will receive a verification email. Click the link inside your email to verify.
Step 4: Click the “Apply Online” link to complete your portion of the form.
Step 5: Complete all required fields in the form. Note: The Requestor is the person completing this form. The Requestor can be the equipment user or that person's family member, caregiver, or another trusted individual. The Requestor should not be the healthcare provider.
Healthcare Provider Portion: Within the form, you will select the method in which you will send the remainder of the form to be completed by your healthcare professional, either:
1. Online via email (your provider will create a OneStop account similar to Steps 1, 2, and 3), or
2. Print a hard copy and bring it to your healthcare professional, then upload the completed document after logging back into OneStop (must use scanner, cell phone/tablet photos will not be accepted).
Acceptable Healthcare Professionals: Physicians, Physician Assistants (PA), Nurse Practitioners (CRNP), Physical Therapists (PT), and Occupational Therapists (OT) ONLY - requests for power wheelchairs and power scooters must be completed by a Physical Therapist or Occupational Therapist ONLY.
Please Note: It is the responsibility of the Healthcare Professional to select the appropriate equipment for the beneficiary. The healthcare professional should include any additional information that may assist in providing the appropriate equipment (seat width, seat depth, etc.)
What to Expect after Submitting a Request Form:
Once we receive and process a completed request form, we will contact the Requestor, via the contact information provided, to notify them if the requested equipment is in-stock. If the equipment is in-stock, a pick-up appointment will be scheduled.
Pickup Appointment:
Equipment pickup is by appointment only. MD DME Re-Use will contact the Requestor to schedule the pickup appointment after a request from is processed. Delivery Is not available. Pickup persons must load equipment independently.
Option 2: Request Complex DME Using a Hard Copy Form
Step 1: Obtain a Request Form
Click the link below to download the
Complex DME Form. Print the Complex DME form, then complete the Request Form using blue or black ink. If you are unable to print the Complex DME form, call 240-230-8000 or
email us to request a hard copy of the form to be mailed to you for completion.
Step 2: Complete a Request Form
Complete Part A: Complete Part A. Note: The Requestor is the person completing Part A. The Requestor can be the equipment user or that person's family member, caregiver, or another trusted individual. The Requestor should not be the healthcare provider.
Pass the Request Form to a Healthcare Professional to Complete Parts B and C: Parts B and C must be completed by a Healthcare Professional treating the beneficiary.
Acceptable Healthcare Professionals: Physicians, Physician Assistants (PA), Nurse Practitioners (CRNP), Physical Therapists (PT), and Occupational Therapists (OT) ONLY - requests for power wheelchairs and power scooters must be completed by a Physical Therapist or Occupational Therapist ONLY.
Please Note: It is the responsibility of the Healthcare Professional to select the appropriate equipment for the beneficiary. The healthcare professional should include any additional information that may assist in providing the appropriate equipment (seat width, seat depth, etc.)
Step 3: Submitting a Request Form
After parts A, B, and C are completed, the Request Form should be submitted (by either party) to our program via mail, email, or fax. Please Note: All fields denoted with an “*” are REQUIRED. Failure to provide this information will void your request.
Mail:
Maryland Durable Medical Equipment Re-Use
11701 Crain Highway
Cheltenham, MD 20623
Scan and Email:
Scan the completed form
(cell phone/tablet photos will not be accepted) and email to:
DME.MDOA@maryland.gov
Fax:
240-230-8004
What to Expect after Submitting a Request Form:
Once we receive and process a completed request form, we will contact the Requestor, via the contact information provided, to notify them if the requested equipment is in-stock. If the equipment is in-stock, a pick-up appointment will be scheduled.
Pickup Appointment:
Equipment pickup is by appointment only. MD DME Re-Use will contact the Requestor to schedule the pickup appointment after a request from is processed. Delivery Is not available. Pickup persons must load equipment independently.
FAQs:
Q: Is a formal prescription for DME required? A: A formal prescription is NOT required; we only require our Request Form to be completed - including Part C completed by a Healthcare Professional treating the beneficiary (Physician, Physical Therapist, Occupational Therapist, Physician’s Assistant, or Certified Registered Nurse Practitioner).
Q: How long can the Beneficiary keep the equipment?A: Once equipment is provided to a Beneficiary, it is theirs to keep. Once the equipment is no longer needed, please donate it back to our program so we may redistribute it to another Maryland resident in need.
Please note the Requestor will take ownership of the equipment. The Requestor is the individual who completes the form and signs the Liability Waiver and Release agreement in Part A, page 2 of the Request Form. The Requestor, the Beneficiary, and the pick-up person may be three different people, two different people (for example, the Requestor and Beneficiary can be the same person while the person picking up is a second person), or one person.
Q: Does your program deliver equipment directly to the Beneficiary?
A: We are currently NOT able to provide direct deliveries or provide installation/setup. Equipment must be picked up at one of our sites by the Beneficiary or another trusted individual on behalf of the Beneficiary. The individual designated as the “Person Picking Up the Equipment” should be detailed on the Request Form, Part A.
Q: Where can requested DME be picked up?A: For most types of equipment we provide, we can transport the equipment to one of our satellite sites around the state for a more convenient pickup location. For what we consider to be Complex DME, these items must be picked-up at our Re-Use Center in Cheltenham, MD.
Complex DME includes: manual wheelchairs, transport wheelchairs, power wheelchairs, power scooters, home hospital beds, mechanical “Hoyer” lifts, and/or any other advanced equipment as determined by the program.
If a Beneficiary is approved to receive DME from us, when applicable, we will arrange for a pickup at a site nearest to them.
Q: What if I have other questions that aren’t addressed here?A: Please, contact us! The best way to get your questions answered is to contact our program directly. Call 240-230-8000 or email DME.MDOA@maryland.gov
Donating Equipment:
For additional information on donating equipment, visit our webpage or refer to this document of frequently asked questions
FAQ.
