The Process for Physicians
If you have identified a patient that has a condition that could benefit from the use of a Compression Therapy System (Lymphedema, Venous Insufficiency) :
You will need to write a prescription for a pneumatic compression pump to treat the appropriate condition. The prescription must identify the area of the body to be treated, (ex. Bilateral Legs, Right Leg, Left Leg, Right Arm, Left Arm), how many times per day the pump is to be used, and length of each treatment cycle.
You must provide the patient's demographic information, including the patient's insurance and a copy of the diagnosis and signed progress notes outlining the provider's recommendation for compression pump therapy.
Fax the prescription to Midwest Compression at 800-886-4201, at which point Midwest Compression will seek to obtain authorization from the patient's medical insurance provider (if necessary).
Once authorization is obtained (wherever applicable), Midwest Compression will contact the patient directly to set up an in-home appointment to fit, set up, and educate the patient on how to use that pump. The trained installer will test the pressures for the patient and ensure patient is comfortable with the pump.
Midwest Compression will send a delivery confirmation for the medical record.
FAX: 800-886-4201
Click the links below to view Compression Pump Referral Instructions and download the Midwest Compression Referral Form
Compression Pump Referral Form: PDF
Compression Pump Referral Instructions
(Have provider complete form and fax to: 800-886-4201)
Compression Wrap Form and Process
Compression Wrap Referral Instructions: PDF
(Have provider complete form and fax to: 800-886-4201)
Click the links below to view DVT Pump Referral Instructions and DVT Referral Form.
(FAX TO: 800-886-4201)
(Have provider complete form and fax to: 800-886-4201)
For other patient documents/forms please visit our document center below