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- Click ‘Get Form’ to open the ZIO™ Patient Enrollment Form in the editor.
- Begin by indicating whether the patient has used an iRhythm product before by selecting 'Yes' or 'No'.
- Fill in the Account Information section, including Account Name, Phone, Fax, Address, City, State, and ZIP Code.
- In the Patient Information section, enter the Patient Name (Last, First), Patient ID (if applicable), Birth Date, and complete the address fields. Ensure to provide both Primary and Secondary Phone numbers.
- Select the patient's sex and indicate if they have a Pacemaker or Implanted Cardiac Defibrillator by checking 'Yes' or 'No'.
- Complete the Service Information section by selecting the Monitoring Start Date and choosing between Zio™ Event Card or Zio™ Patch. Provide details for Managing Physician and Referring Physician if applicable.
- Indicate whether iRhythm staff will provide enrollment service and if the device should be sent directly to the patient.
- Lastly, select the reason for device prescription from the provided options.
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| Versions | Form popularity | Fillable & printable |
|---|---|---|
| 2010 | 4 Satisfied (48 Votes) |
Is zio heart monitor covered by insurance?
The Zio system is covered by Medicare3 nationwide. Patients with Commercial Insurance: All major commercial insurance plans cover the Zio system. Depending on their plan and benefits, patients may have an out-of-pocket responsibility.
Why would a doctor order a Zio patch?
Zio ECG monitors have been worn by millions of patients4 to help detect irregular heart rhythms, including atrial fibrillation. With just a single test, your doctor will be provided high-quality, actionable heartbeat data3 to help deliver the care that you need.
What is the phone number for 888 693 2401?
iRhythm offers a number of payment programs tailored to your needs, including our financial assistance program and prompt pay discount. Our patient advocates can help you determine which payment option might be right for you. Contact us at 1-888-693-2401 to speak with an iRhythm patient advocate.
Is iRhythm a real company?
iRhythm is a leading digital health care company that creates trusted solutions that detect, predict, and prevent disease. Combining wearable biosensors and cloud-based data analytics with powerful proprietary algorithms, iRhythm distills data from millions of heartbeats into clinically actionable information.
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Related links
Jul 27, 2018 (888)693-2401. Charged Party / Respondent Additional Service iRhythm Technologies, 650 Townsend Street Suite 500. San Francisco, CA 94103-6227
Who do I call if I have any questions? Please call 1-888-693-2401 if you have questions about wearing the monitor, or if you have cost or billing questions.