Get Edgepark Pleurx Order Form 2020-2025
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How to fill out the Edgepark Pleurx Order Form online
Filling out the Edgepark Pleurx Order Form online is a crucial step in ensuring timely access to essential medical supplies. This guide provides clear and supportive instructions to help users navigate the form effectively.
Follow the steps to complete the Edgepark Pleurx Order Form online.
- Click ‘Get Form’ button to retrieve the form and open it in your editing tool.
- Begin with the patient information section. Enter the patient's last name, first name, and middle initial. Include their primary phone number and an alternate contact name with their phone number if available. Then, fill in the patient's address, including city, state, and ZIP code.
- Proceed to the insurance information section. Provide details for primary insurance, including the name of the insurance provider, their contact phone number, policyholder details, ID number, employer or group name, and the group number. If applicable, complete the secondary insurance information similarly.
- Fill out the hospital information, documenting the hospital name, placement date, discharge date, and the name of the PleurX contact at the physician's office. Include the name of the referring physician.
- In the patient care section, indicate the vacuum bottle size needed and where the patient is being discharged to. Complete details on the number of bottles discharged and include the care start date along with the provider’s name and contact information.
- Review the section confirming the request for prescription confirmation. Indicate your preferred contact method (phone or email) for confirmation.
- Conclude by ensuring that you have addressed the notes section and fax the completed form to the designated number: 877.307.6350. You may also need to preserve the original order or send it to Edgepark Medical Supplies.
- Finally, upon completion, users can save changes, download, print, or share the form as needed.
Complete your Edgepark Pleurx Order Form online today for efficient processing.
The frequency of draining pleural effusion depends on the severity of fluid accumulation. Some patients may need to drain it weekly, while others may require more frequent sessions. Continuous monitoring by your healthcare team is important for your health. To assist with your drainage needs, consider using the Edgepark Pleurx Order Form for easy access to necessary supplies.
Fill Edgepark Pleurx Order Form
Order Your Pleurx Drainage Kit with 1000mL Vacuum Bottle Through Insurance With Edgepark Today! Edit, sign, and share pleurx catheter order form online. Our home medical products can be delivered right to your patients' doorstep, allowing them to focus on the moments that matter most. Explore state-specific Edgepark Order Forms and edit them online.
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