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Ck Sign Up or call Navinet Customer Care at 1-888-482-8057. Mobility Evaluation Report for Scooter DME Fax # (609) 583-3023 DME Phone # (800) 682-9094 x 81017 Is this the: Initial Replacement. Reason: Member Name: Member ID #: DME Provider: DOB: DME Provider Contact Name: DME Provider Contact Phone #: DME Provider Contact Fax# : Current Symptoms, Related Diagnosis, and History (Must be completed by Treating Practitioner) What medical conditions/diseas.

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