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Medicare Scope of Appointment

Per CMS (Medicare) mandated guidelines, all face to face appointments requires the completion of a Scope of Appointment form to be filled out by the beneficiary. Please see below for the Scope of Appointment form. This will serve as a confirmation of our appointment and keep us in line with CMS regulations. You can simply return prior to our appointment by faxing or mailing to our office. Thank You.

Dowlonad 2015 Medicare Scope of Appointment Form

Use This Example as a Guideline to Fill Out the Scope of Apointment Form2015 Medicare scope of appointment

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