Home
Forms Library
VNS Therapy Eligibility and Education Form

VNS Therapy Eligibility and Education Form 2025

VNS Therapy Eligibility and Education Form Preview on Page 1

See details

4.9 out of 5

42 votes

The document is a VNS Therapy Eligibility and Education Form used by physicians to collect patient information and insurance details for vagus nerve stimulation therapy. It includes sections for physician and patient information, diagnosis codes, insurance verification, and authorization for the release of protected health information (PHI) to LivaNova, Inc. The form aims to facilitate the assessment of coverage for VNS implants and provide education on the therapy.

Here's how it works

01. Edit your form online

Type text, add images, blackout confidential details, add comments, highlights and more.

02. Sign it in a few clicks

Draw your signature, type it, upload its image, or use your mobile device as a signature pad.

03. Share your form with others

Send it via email, link, or fax. You can also download it, export it or print it out.

The easiest way to modify VNS Therapy Eligibility and Education Form in PDF format online

Ease of Setup

DocHub User Ratings on G2

Ease of Use

DocHub User Ratings on G2

Working on documents with our extensive and user-friendly PDF editor is straightforward. Follow the instructions below to complete VNS Therapy Eligibility and Education Form online easily and quickly:

Log in to your account. Sign up with your email and password or register a free account to test the product before choosing the subscription.
Upload a form. Drag and drop the file from your device or add it from other services, like Google Drive, OneDrive, Dropbox, or an external link.
Edit VNS Therapy Eligibility and Education Form. Effortlessly add and highlight text, insert images, checkmarks, and signs, drop new fillable areas, and rearrange or delete pages from your document.
Get the VNS Therapy Eligibility and Education Form accomplished. Download your updated document, export it to the cloud, print it from the editor, or share it with others via a Shareable link or as an email attachment.

Benefit from DocHub, one of the most easy-to-use editors to promptly handle your documentation online!

See more VNS Therapy Eligibility and Education Form versions

We've got more versions of the VNS Therapy Eligibility and Education Form form. Select the right VNS Therapy Eligibility and Education Form version from the list and start editing it straight away!

Versions	Form popularity	Fillable & printable
2018	4.1 Satisfied (30 Votes)
2016	4.9 Satisfied (42 Votes)

be ready to get more

Complete this form in 5 minutes or less

Get form

Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

Who is a candidate for VNS?

You may be a good candidate for VNS if you have epilepsy that is not adequately controlled with at least two different anti-seizure medications (age four and older). For depression, you may be eligible if your symptoms have not had an adequate response to four or more antidepressant medications (age 18 and older).

What are the symptoms of a bad vagus nerve?

Signs someone may have vagal dysfunction: changes to heart rate, blood pressure or blood sugar. difficulty swallowing or loss of gag reflex. dizziness or fainting on standing. hoarseness, wheezing or loss of voice. loss of appetite, feeling full quickly, bloating, unexplained weight loss, nausea and vomiting.

Who is not a good candidate for VNS?

People with significant asthma or other breathing problems, sleep apnea, or some heart problems may be advised against using vagus nerve stimulation. Sometimes, other medical problems like these could get worse with VNS.

Who qualifies for a VNS?

VNS therapy is usually considered if you have tried a number of ASMs which have not fully controlled your seizures, and if you are not suitable for, or do not want to have, brain surgery.

Who should not get a VNS?

Who should not receive vagus nerve stimulation (VNS)? You may not be a candidate for vagus nerve stimulation if: Youre pregnant. Have breathing problems, including asthma, sleep apnea, chronic obstructive pulmonary disease or other lung diseases and disorders.

Who qualifies for vagus nerve stimulation?

Can I be considered for VNS therapy? VNS therapy is usually considered if you have tried a number of ASMs which have not fully controlled your seizures, and if you are not suitable for, or do not want to have, brain surgery.