Negative Pressure Wound Therapy
FILLING OUT THE NPWT INITIAL ORDER FORM:
Complete all three pages
Make sure the patient name and ALL lines are completed in the prescribers box on page 3.
Print and have the physician sign and date, fax back to us at 888-665-4199.
Once completed orders and clinical information are received by us, we will submit for authorization (if required).
If you are treating more than one wound complete a Secondary Wound Order Form also.
1) Click on the pdf icon at the above
2) When pdf file comes up in the pdf reader, use the icon button on the far right at the top of the page to switch to full page view (see example)
3) Use the controls at the bottom of the page (which will appear as you roll over the area) to download the file to your hard drive:
Initial Order Form, 3-pages
Expertise you Trust Service you Deserve