Prescription & Letter of Medical Necessity - zynex 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the Patient Name and Date of Birth in the designated fields. Ensure accuracy as this information is crucial for processing.
3. Fill in the Primary Phone and Secondary Phone/Email fields to ensure communication regarding the prescription.
4. Indicate the Date of Injury and Date of Surgery if applicable, as these details support medical necessity.
5. Select the appropriate equipment needed, such as E-Stim devices or Spinal Orthosis, and provide corresponding DX Codes where required.
6. Specify Length of Need by checking either Life-time or a specific duration (3-18 Months).
7. Complete any additional sections related to Hot/Cold Therapy, including Length of Need and Treatment Plan options.
8. Finally, ensure that the Prescriber’s Signature, Date, Printed Name, and NPI are filled out before submitting.

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