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How do I fill this out?
To fill out this form, first ensure you have accurate measurements. Use the specified measuring points for your patient while they are lying down. Finally, complete all required fields and submit via email or fax.
How to fill out the JOBST UlcerCARE Compression System Order Forms?
1
Measure the patient's leg accurately using the measuring board.
2
Fill in the patient's details including name, date of birth, and contact information.
3
Select the appropriate size and color for the compression garment.
4
Ensure the form is signed if necessary and includes the purchase order number.
5
Submit the completed form to the provided email or fax number.
Who needs the JOBST UlcerCARE Compression System Order Forms?
1
Patients with venous ulcers who require compression therapy.
2
Healthcare providers prescribing compression garments for patients.
3
Clinical staff needing to document patient measurements accurately.
4
Medical supply companies ordering compression garments on behalf of patients.
5
Insurance companies verifying prescriptions for reimbursement.
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What are the instructions for submitting this form?
To submit this form, fax it to customer services at 0845 122 3450 or email it at compression.uk@jobst.com. Ensure all required fields are filled out accurately before submission. For online submission, follow instructions provided on the JOBST website.
What are the important dates for this form in 2024 and 2025?
No specific important dates are applicable for this form in 2024 and 2025 as it is used on an ongoing basis.
What is the purpose of this form?
The purpose of this form is to facilitate the prescription and ordering process for compression garments necessary for patients with venous leg ulcers. It ensures that accurate measurements are taken to provide the proper fit and patient comfort. By gathering essential information, the form helps streamline communication between patients, healthcare providers, and suppliers.
Tell me about this form and its components and fields line-by-line.
- 1. Patient Name: Full name of the patient requiring compression therapy.
- 2. Date of Birth: Patient's date of birth for identification.
- 3. Contact Information: Includes phone number and email for communication.
- 4. Size and Color Selection: Fields for choosing size and color of the garment.
- 5. Measured By: Name of the person who took the measurements.
What happens if I fail to submit this form?
If the form is not submitted correctly, the order for compression therapy cannot be processed. This could lead to delays in receiving essential treatment and may impact patient health. Ensuring all fields are filled accurately is critical to avoid complications.
- Incomplete Measurements: Without accurate measurements, the fit of the compression garment cannot be guaranteed.
- Incorrect Patient Information: Inaccurate details may cause delays in processing orders.
- Missing Signatures: Required signatures ensure that consent has been obtained for data processing.
How do I know when to use this form?
- 1. Prescribing Compression Therapy: When healthcare providers need to prescribe garments for patients.
- 2. Ordering Stock for Medical Supplies: Used by suppliers to obtain the right products for their inventory.
- 3. Patient Measurement Documentation: Records measurements for multiple patients to streamline future orders.
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