MedicaidAdministrativeMedium impact
Revisions to DME Questionnaires and Posting to Web Site
Illinois Medicaid - HFS·IL · PM&R (Physical Medicine & Rehab), Orthopedics, Pulmonology +1 more·Provider Notice
Effective date
Oct 23, 2007
We identified it
Jun 21, 2026
Summary
Several DME questionnaires have been revised and moved to the Illinois Medicaid website for downloading. Key changes include a revised C-PAP/BiPAP renewal form (3701F), updated power wheelchair forms (3701H and 3701K), and elimination of the orthotic approval form (314A) which will be replaced by physician orders.
Action Required
Immediately: Download newest versions of all DME questionnaires from https://hfs.illinois.gov/medicalforms/ and destroy old versions. Update workflow to use revised 3701F for C-PAP/BiPAP renewals beyond initial 3-month period, new 3701H and 3701K forms for power wheelchairs, and physician orders instead of 314A forms for orthotic services. Print forms from website as they are not fillable electronically.