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How to fill out the Philips Home INR Monitoring online
Filling out the Philips Home INR Monitoring form is an important step for users looking to manage their anticoagulation therapy effectively. This guide provides a clear, step-by-step approach to help you complete the form accurately and efficiently, ensuring that your information is submitted without issues.
Follow the steps to complete the Philips Home INR Monitoring form.
- Click ‘Get Form’ button to obtain the form and access it in your designated document manager.
- Begin by entering the physician information, including practice name, contact person, practice address, physician name, phone number, fax number, and physician NPI number. Also provide a contact email for communication purposes.
- Next, fill in the patient information. This includes gender, full name, social security number, date of birth, address, city, state, zip code, and phone/cell numbers. If applicable, also enter the name and phone number of an alternate contact.
- Provide details about the patient's primary and secondary insurance, including the insurer's name, member ID, phone number, relationship to insured, and insured's date of birth.
- Indicate the patient's primary care physician’s name and phone number. Ensure to attach copies of the front and back of the patient's insurance card and any recent clinical notes.
- Select the patient's diagnosis from the provided options by checking the applicable boxes. If the diagnosis is not listed, write it in the space provided based on the options on the back of the form.
- For notification protocol selection, choose between receiving test results via fax, online reports, or a specified notification method. Fill in the necessary details based on your selection.
- Provide information about and meter. Indicate if the patient has been on for at least 90 days and select the preferred brand for the meter as well as the training provider.
- In the statement of medical necessity/prescription section, confirm the need for long-term therapy, checking relevant boxes that support medical necessity and completing the physician's signature and date.
- Finally, review all entries for accuracy. Save changes, and prepare to submit the document by faxing it with the insurance card to the specified fax number. Make sure to keep a copy for your records.
Start filling out your Philips Home INR Monitoring form online today to ensure timely management of your anticoagulation therapy.
Taking a PT INR sample involves cleaning your finger, using a lancing device to obtain a drop of blood, and applying that blood to a test strip. Ensure you follow the Philips Home INR Monitoring device's guidelines for accurate sampling. Proper technique is crucial to obtaining valid results and maintaining your health.
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