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**Non Prior Authorization Items (Black);
Prior Authorization Required (Orange)**
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Home Care Essentials
First Aid Kit
Home Medical Bag
Bathroom Supplies
Incontinence Garment
Size
Small - 22"-36"
Medium 32"-44"
Large 45"-58"
XL 59"-64"
XXL 63"-69"
Style
Ultra with Tabs
Ultra without Tabs
Super Plus w/Tabs
Super Plus no Tabs
Shower Wall Rail (or) Base
Commode Chair
Zinc Oxide
Mechanical Toilet Lift Seat
Raised Toilet Seat
Absorbent Pads
Transfer Bench
Ostomy Pouch
Urinary Suspensory w/leg bag
Shower Chair (or) Bench
Toilet Rails
Urinal
Type
Male
Female
Catheter
Diabetic Supplies
Shoe Inserts
Insulin Syringe
Glucose Meter
Blood Glucose Strips
Lancets
Gauge
23 Fixed Depth
26 Safety Lancet
Suction Machine
Suction Canister
Volume
1200 mL
2000 mL
Suction Tubing
Respiratory Suction Machine
Suction Catheter
Miscellaneous Items
Alcohol Prep Pads
Size
Medium
Large
Manual B/P Monitor
Compression Stockings Knee
Size
Small-Medium
Large-XL
Hand Sanitizer (4 oz.)
Infrared Heating Pad System
Size
Medium 32"x20"
Large 72"x24"
Large (flexible)
Tens Unit
Oral (Or) Temporal Thermometer
Type
Oral
Temporal
Mechanical Gripper Arm
Compression Stockings Thigh
Size
Small
Medium
Large
XL
Color
Black
Beige
Basic Electric Heat Pad
Water Circulating Heat Pad w/Pump
Tens Unit Pad
Automatic B/P Monitor
Compression Stockings Calf
Size
Small
Medium
Large
XL
Isolation Mask
Shoulder/Neck Head Pad (Preferred)
Alcohol or Peroxide (per pint)
Size
4 oz.
8 oz.
16 oz.
Tens Unit Lead Wires
Beds
Alternating Pressure Pad
Bed Pan (Or) Bottle
Side Rails Full (Or) Half Length
Size
Full
Half
Full Electric H.B w/Mattress
Lambswool Sheepskin Pad
Gel Pressure Mattress
Thickness
10"
12"
Size
Twin
Full
Queen
King
Semi-Electric H.B Mattress
Trapeze Bar
Bed Foot Support
Over the Bed Table
Head and Foot Boards
Mobility Devices
Cane
Knee Pillow
Lift Chair
Wheelchair (Lightweight)
Transport Chair
Leg Rest
Scooter
Options
3-Wheel
4-Wheel
Heavy Duty Walker
Options
Wheels
No Wheels
Quad Cane
Back Cushion (and/or) Seat Cushion
Wedge Pillow
Hoyer Lift
Arm Rest
Hoyer Lift Sling
Size
Medium
Large
XL
Rollator
Color
Red
Blue
Silver
W/C Pressure Pad
Transfer Board
Anti-Tip Device
Safety Vest
Size
Medium
Large
XL
XXL
Lift Chair (Mechanism)
Medical Supplies
Gloves Non-Sterile (Latex)
Size
XS
Small
Medium
Large
XL
Gloves Sterile (Latex)
Size
Small
Medium
Large
XL
Sterile Gloves (both Latex and Vinyl) are currently on backorder. We are unsure when they will be available.
Gloves non-Sterile (Vinyl)
Perineal Spray
Gloves Sterile (Vinyl)
Gauze Sponge
Size
2x2
3x3
4x4
Ply
8
12
16
Gauze Sterile Wrap
Size
Small
Medium
Zinc Oxide Cream
Betadine (Or) Iodine Swabs/ Wipes
Please Choose
Betadine
Iodine
Surgical Mask
Color Preference
Blue
White
Yellow
Saline Flush
Volume
3 mL fill in 10 mL
5 mL
10 mL
Oxygen
Non Electric Spirometer
Stationary Concentrator
Stationary O2 Contents
Humidifier Bottle
Nasal Cannulas
O2 Line Length
4'
7'
Tubing
Portable Concentrator
Stationary Compressed Gas
Portable O2 Contents
Portable Gas O2
Portable Battery
Portable Battery Charger
Portable Concentrator Backpack
External Battery Charger
Regulator
Pulse Oximeter
AffloVest
CPAP/Nebulizer
CPAP Face Mask
CPAP Headgear
CPAP Hose
Nebulizer Dome and Mouthpiece
Equipment Needed
Nebulizer Dome
Nebulizer Mouthpiece
Water Trap
Oxygen Mask
Nebulizer
Portable Nebulizer
Alcohol or Peroxide (per pint)
CPAP Machine
CPAP/Bi-PAP Machine
Nutrition
Ensure
Flavor
Chocolate
Vanilla
Strawberry
Apple
Mixed Berry
Butter Pecan
Boost
Flavor
Chocolate
Vanilla
Strawberry
Style
Carton
Bottle
Electrolyte
Glucerna
Flavor
Chocolate
Vanilla
Strawberry
Butter Pecan
Style
Carton
Bottle
Ensure Pudding
Flavor
Milk Chocolate
Vanilla
Skin Care
Parafin Bath (Hand Wax Unit)
Parafin Wax
Sunscreen
Hand Lotion (4 oz)
First Aid Kit
Special Instructions/items
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