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Click ‘Get Form’ to open the CoaguChek Patient Services Enrollment Guide in the editor.
Begin by filling out the Patient Information section. Enter the patient's first name, middle initial, last name, gender, home address, city, state, ZIP code, date of birth, and contact numbers.
Complete the Assignment of Benefits and Release of Information section. Ensure that the patient reads and understands this statement before signing and dating it.
Fill in the Physician Order Form. Include all required fields such as diagnosis codes and prescribed frequency for testing. Make sure to sign and date this form as well.
Once all sections are completed, fax or mail the forms to CoaguChek Patient Services using the provided contact information.
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Patient self-testing services are typically covered by Medicare and most insurance providers Actual coverage, reimbursement and out-of-pocket costs depend on a number of factors and vary by plan. *You may also send this form to your regional office. Please refer to the CoaguChek Patient Services Regional Offices map.
How long does a CoaguChek machine last?
Do self-test machines have a limited life span? Yes, the coaguchek INRange machine has a life span of 600 INR tests. Once 600 tests are carried out a new machine will need to be purchased. However, as long as the machine is only used to test INRs when necessary, it will last many years without needing replacing.
How do I calibrate a CoaguChek device?
No, calibration is performed automatically upon inserting the code key from the strip vial. NOTE: Important to keep the code key and not discard it when opening the strip vial. If you use a new test strip lot and have not inserted the corresponding code chip yet, you must do so at latest after inserting the test strip.
What is the phone number for Roche CoaguChek?
If you or your patients have questions, live technical support is available by phone. 1-800-428-4674.
How do I calibrate my CoaguChek?
What is time in therapeutic range (TTR)? The percentage of time that your patients INR values fell within the upper and lower target value set by you. Do the CoaguChek systems need calibration? No, calibration is performed automatically upon inserting the code key from the strip vial.
If you have any questions, please contact CoaguChek Patient Services at 1-800-780-0675.
coagucheklink
Point of Care- Prothrombin Time (INR), CoaguChek
Prothrombin time and INR are monitored in the point of care for patients taking oral anticoagulants, which allow physicians to adjust medications levels.
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