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Click ‘Get Form’ to open the tens unit prescription form in the editor.
Begin by entering the 'Date of Order' at the top of the form. This is essential for tracking the prescription timeline.
Fill in the 'Patient Demographics' section, including Name, Sex, Date of Birth, Address, City, State, Zip Code, and both Home and Work phone numbers. Ensure accuracy for effective communication.
In the 'Referring Physician Demographics' section, input the Physician's Name along with their UPIN and NPI numbers. This information is crucial for insurance processing.
Select the prescribed items from the 'Items Prescribed' section by checking the appropriate boxes for equipment and supplies needed.
List any qualifying diagnoses in the designated area. This helps justify the medical necessity of the TENS unit.
Finally, ensure that you have a space for the Physician's Signature and Date at the bottom of the form before submitting it.
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Insurance may cover a TENS unit if the treatments are medically necessary. You can buy a TENS unit without a prescription. But, you may need documentation from your doctor to get your insurance to cover it.
What is the medical necessity for a TENS unit?
You will be loaned a TENS machine from a company called Nidd Valley - initially for a two-week trial, free of charge. You will fill in a loan form, then go over contraindications and precautions to make sure you are suitable to use the TENS before it is issued.
Can I get a tens machine on prescription?
TENS units are considered medically necessary when prescribed as a treatment for pain for those who have not responded to other modalities, in the following situations: Pain related to musculoskeletal conditions; or. Pain associated with active or post trauma injury.
How to get a prescription for a TENS unit?
Many healthcare providers offer TENS therapy in office or hospital settings. They can also give you a prescription for a TENS unit to use at home. Or you can purchase an over-the-counter (OTC) TENS unit at your local pharmacy without a prescription.
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Center for Pain Management New Patient Intake Form
TENS Unit. ☐. ☐. ☐. Pain Description. Diagnostic Tests and Imaging. Please mark all of the following treatments you have had for pain relief: ☑. No Change.
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