Prescriptions

To better serve our referral sources and patients, AeroCare has specialized intake areas, each staffed with individuals knowledgeable about the specific products and/or therapies and the medical information required to process the order. They will ask the necessary questions to process the order, schedule the delivery and initiate the process for verifying coverage of the order. 

By Fax

Fill out an AeroCare fax cover sheet and fax to 262.957.5535. To ensure we have all the necessary information, please call when sending a fax to verify that we received your order. 

General Fax Cover Sheet Equipment Order Form

Oxygen Prescription: Oxygen and Neb  Oxygen Order Checklist

Cough Assist AffloVest Prescription Form

PAP PAP Order Checklist

Nebulizer Nebulizer Order Checklist AeroCare's Home Delivery Service

Durable Medical Equipment  DME Prescription Form Medicaid DME + Respiratory Order Form

Ventilators  Ventilator Order Checklist

Walkers (2-Wheel and 4-Wheel) DME Prescription Form

Wheelchairs Wheelchair Equipment Order Form

Post-Mastectomy Post-Mastectomy Prescription Form

Bracing and Compression Prescription: Bracing Prescription: Graduated Medical Compression Garments

Wound Care Prescription: Wound Evaluation Form  Prescription: Burn Wound Evaluation Form

 

By Phone 

Call 262.786.9870 or visit our Contact Us page to find the proper department. Please be prepared to provide the following information:

• patient’s name, address, home phone number, e-mail address, date of birth and diagnosis
• patient’s insurance information (including group number and employer of policy holder)
• name and date of birth of policy holder
• referral’s name, phone number and e-mail address
• physician’s name and e-mail address