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  • Order Form For Cardiac Rehab

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Outpatient Cardiac Rehabilitation Physician Order Form Medical Center of Lewisville 500 W. Main Street Lewisville TX 75057 Phone 972-420-1526 Fax 972-219-7506 Patient Name DOB Phone Home Cell Patient Diagnosis / Procedure Dates MI within 1 yr of infarction PCI PTCA / Stent within 3 months of surgery CABG within 3 months of surgery Heart Valve Replacement within 3 months of surgery Stable Angina must meet special criteria Pacemaker/ICD Heart Trans.

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SF-36 is a fast, validated and easy way of assessing global QOL in patient undergoing ambulatory CR, and is positively correlated with exercise capacity and male sex, but not age and LVEF. Its use should be systematic to evaluate efficacy of a CR program on improving QOL.

G0422. Intensive cardiac rehabilitation; with or without continuous ECG monitoring with exercise, per session. G0423. Intensive cardiac rehabilitation; with or without continuous ECG monitoring; without exercise, per session.

As part of the Medical Outcomes Study (MOS), a multi-year, multi-site study to explain variations in patient outcomes, RAND developed the 36-Item Short Form Health Survey (SF-36) in 1992. SF-36 is a set of generic, coherent, and easily administered quality-of-life measures.

Cardiac Rehabilitation Program No more than two one-hour sessions, utilizing any combination of the CPT® or HCPCS codes (93798, 93797 or G0422, G0423) will be allowed per day for up to 36 sessions over a maximum of 36 weeks (Phase IIA).

Providers may bill HCPCS codes G0422 and G0423 for a maximum of six one-hour sessions of intensive cardiovascular rehabilitation per day and up to 72 one-hour sessions over an 18-week period. The combined total number of sessions billed with HCPCS codes G0422 and G0423 must not exceed 72 in an 18-week period.

To score the SF-36, scales are standardized with a scoring algorithm or by the SF-36v2 scoring software to obtain a score ranging from 0 to 100. Higher scores indicate better health status, and a mean score of 50 has been articulated as a normative value for all scales.

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© Copyright 1997-2025
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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232