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OFFICE OF VERMONT HEALTH ACCESS VERMONT MEDICAID MEDICAL NECESSITY FORM MNF ORTHOTICS PROSTHETICS MEDICAL SUPPLIES EQUIPMENT FOR IN-HOME USE All claims for supplies and equipment require a written physician order. Copies of the order must be kept in the patient record by both the physician and DME suppIier. It is the responsibility of the ordering physician to complete or review this Medical Necessity Form MNF and provide adequate documentation/.

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