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).
Download to your hard drive and fill out form electronically.
Once physician has signed and dated completed orders, fax to 888-665-4199