Get Ptinr Com

Filling out the Ptinr Com form for Home INR Monitoring is a straightforward process that requires careful attention to detail. This guide provides step-by-step instructions to assist users in completing the form efficiently.

Follow the steps to complete the Ptinr Com form online.

1. Press the ‘Get Form’ button to access the form and open it in your preferred editor.
2. In the 'Patient Information' section, enter the patient's first name, middle initial, last name, phone number, and date of birth. Ensure that the demographics sheet is attached as required.
3. Proceed to the 'Physician Information' section. Fill in the prescribing physician's details, including their name, NPI number, group practice or hospital name, office phone, and office fax. If applicable, also provide the managing physician's information.
4. Select the type of monitoring device in section 'E' by checking the relevant option among Alere INRatio®2, ITC ProTime®, and Roche CoaguChek® XS.
5. Indicate the training preference in the training section. Choose from options such as face-to-face training organized by Alere or staff-led training.
6. In the 'Diagnosis' section, mark the primary diagnosis by checking only one option. Additionally, provide the ICD-9-CM code. For secondary diagnoses, select up to three applicable options and include their codes.
7. Specify the testing frequency by selecting either '2-4 times per month' or 'weekly'. Note that Medicare covers up to 52 tests per year.
8. Enter the start date in the required format (mm/dd/yyyy).
9. Fill in the target INR range by specifying the low and high values.
10. Review the statement of medical necessity/prescription section which includes important certifications regarding the patient's self-testing.
11. Finally, ensure the physician's signature is included, along with the date and A/C number. This is critical for compliance.
12. Once all sections are completed, save your changes. You can also download, print, or share the form as needed.

Complete your documents online today for a seamless experience.