Urology Prescription Form - Prism Medical Products 2026

1. Click ‘Get Form’ to open the Urology Prescription Form in the editor.
2. Begin by entering the RX DATE at the top of the form. This is essential for tracking prescription timelines.
3. Fill in the PATIENT’S NAME and DEMOGRAPHIC/INSURANCE INFORMATION, including date of birth and contact details. Accurate information ensures proper processing.
4. In the INTERMITTENT CATHETER DETAILS SECTION, specify what type of catheter is needed by selecting from options like Sterile Intermittent Catheters or Closed/Touchless Kits.
5. Indicate whether a STRAIGHT or COUDE’ TIP catheter is required, and provide necessary diagnosis codes if applicable.
6. Select the appropriate FRENCH (FR) SIZE and LENGTH of catheter needed based on patient requirements.
7. Complete any additional sections regarding lubricant needs, latex allergies, and frequency of catheterization as necessary.
8. Finally, ensure both PROVIDER'S APPROVAL and PATIENT'S APPROVAL sections are signed to validate the prescription.

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