b'Medicare Capped Rental and Inexpensive or RoutinelyBIOPLUS SPECIALTY PHARMACY PATIENT GUIDEBOOKPurchased Items Notification for Services on or After January 1, 2006I received instructions and understand that Medicare defines the _______________________________that I received as being either a capped rental or an inexpensive or routinely purchased item. _____FOR CAPPED RENTAL ITEMS:Medicare will pay a monthly rental fee for a period not to exceed 13 months, after which ownership of the equipment is transferred to the Medicare beneficiary.After ownership of the equipment is transferred to the Medicare beneficiary, it is the beneficiarys responsibili-ty to arrange for any required equipment service or repair.Examples of this type of equipment include:Hospital beds, wheelchairs, alternating pressure pads, air-fluidized beds, nebulizers, suction pumps, continousairway pressure (CPAP) devices, patient lifts, and trapeze bars._____FOR INEXPENSIVE OR ROUTINELY PURCHASED ITEMS:Equipment in this category can be purchased or rented; however, the total amount paid for monthly rentals cannot exceed the fee schedule purchase amount.Examples of this type of equipment include:Canes, walkers, crutches, commode chairs, low pressure and positioning equalization pads, home blood glucose monitiors, seat lift mechanisms, pneumatic compressors (lymphedema pumps), bed side rails, andtraction equipment.I select the: Purchase Option _______________ Rental Option __________________________________________________________ _________________________Beneficiary Signature Date Medicare Patients- Please Keep For Your Records26 The BioPlus Family of Pharmacies'