Alere home inr monitoring 2026

1. Click ‘Get Form’ to open the alere home INR monitoring document in the editor.
2. Begin by filling out the 'Patient Information' section. Enter the patient's first name, middle initial, last name, phone number, and date of birth. Ensure that you attach the demographics sheet as indicated.
3. Next, complete the 'Physician Information' section. Provide details for the prescribing physician including their NPI number, group practice or hospital name, office phone, and fax numbers. If applicable, include information for a managing physician.
4. In section three, select the appropriate monitoring device from options like Alere INRatio®2 or Roche CoaguChek® XS.
5. For training preferences, indicate whether face-to-face training is required or if your staff will train the patient.
6. Fill out the diagnosis sections by checking only one primary diagnosis and up to three secondary diagnoses along with their corresponding ICD-9-CM codes.
7. Specify test frequency by selecting either '2-4 times per month' or 'Weekly'.
8. Enter the Warfarin start date in mm/dd/yyyy format and specify the target INR range.
9. Finally, review and sign the statement of medical necessity/prescription section before submitting your completed form.

Start using our platform today to streamline your form completion process for free!