Durable Medical Equipment Request Form Details

last revised 04/16/24 at 10:32 am

Durable Medical Equipment Request Form

Maryland Durable Medical Equipment Re-Use

Complete and submit the form below to request:

  • Canes, crutches, and walkers
  • Rollators
  • Shower chairs and tub transfer benches
  • Bedside commodes and toilet safety rails
  • Bedrails and transfer boards

The following items may be requested. Requestors seeking any of the items below must provide a Complex Request Form (Parts B and C) completed by a healthcare provider.  

  • Manual wheelchairs
  • Transport wheelchairs
  • Knee Scooters
  • Semi/Electric Home Hospital Beds
  • Patient (Hoyer) Lift
  • Trapeze Bars
  • Overbed Tables
  • Power wheelchairs (Physical or Occupational Therapist only)
  • Power Scooter (Physical or Occupational Therapist only)

Click the Blue “Apply Online” button below to begin your request.

Apply or Register

Ready to apply?


Review the steps - read carefully

  1. Click "Apply Online" above to begin completing a request form. Once complete, click "Submit" at the bottom of the form. Note that all fields denoted with an “*” are required. Failure to provide this information will void your request

Resources and Links

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What Happens After Submission

Read carefully

  1. After a form is submitted, the form will be "In-Review". Once reviewed, we will contact you via the preferred method of contact provided to inform you if the requested equipment is in-stock and to schedule a pickup appointment.


Who issues the Form?

Maryland Department of Aging aging.maryland.gov/pages/DME.aspx

Contact Information

Durable Medical Equipment Re-Use Team

Email: dme.mdoa@maryland.gov