Negative Pressure Wound Therapy
FILLING OUT THE NPWT SECONDARY WOUND ORDER FORM:
Complete the following form if you are requesting to treat more than one wound and return with the Initial Order.
Fill out all pages electronically making sure the patient name and ALL lines are completed in the prescribers box.
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).
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)
The icons on the far left side are for saving (downloading) to hard drive or for printing the form.
4) Download to your hard drive and fill out form electronically.
5) Once physician has signed and dated completed orders, fax to 888-665-4199
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:
Secondary Wound Order Form, 1 page
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