| How Do I Refer My
Patient? |
As your
patient wishes to use the AdvantaJet® for delivery of Insulin we need to have
information in respect of that patient. In order to provide prompt delivery of
the Jet to your patient would you please have your patient complete the enclosed
referral form. You, the doctor / educator, need to complete the appropriate
sections and fax the form to the following number: 1.703.935.7530
or mail it to 7343 Surf Drive, Kempton, PA 19529
Once received, we will contact the patient to collect any additional
information necessary.
A prescription is required, (Our prescription
form is included in the following information). If the patient intends to file a
claim with the appropriate third payer, then a statement of medical necessity
should be completed. A form for this use is included for your convenience,
although certainly, your own documentation may be utilized. If applicable,
please have this form completed and faxed to the appropriate funding agency.
If your patient has questions concerning the system, have him or her
call 866.640.6890. One of our Carousel consultants will provide any information
requested. If you have questions or require any additional information or
supplies, please contact us at the above number. |
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