Provider Resources
Everything your office needs to refer to us
For physicians, vein and wound clinics, and their staff. How to send an order, what documentation each product needs, and handouts to give your patients — all in one place.
How to send a referral
Three ways to send it — pick one
Secure online portal
Fill in the patient's details and upload the Rx, chart notes and measurements. HIPAA-secure.
Send a referral →Parachute Health
Order electronically and track status. Step-by-step guides for E0651, E0652 and garments are in the downloads below.
Order on Parachute →Fax 800-886-4201
Fax the Rx and documents with our cover sheet. Questions? Call 800-883-1549.
Get the fax cover sheet →What to include
Compression garments
- Signed, dated Rx — garment type, compression level (mmHg), length or style, quantity
- Diagnosis with ICD-10 code
- Most recent progress note (past 6 months) — needed when insurance applies (lymphedema, or a venous ulcer under care)
- Lymphedema garments: the diagnosis must be in the treating provider’s own note (MD, DO, NP, PA or CNS). A therapist note can’t be used for the diagnosis, even if co-signed. The therapist note covers each item’s manufacturer, model, quantity, size and color.
- Measurements, if your clinic measured — otherwise we measure in our store
- Face sheet with demographics, insurance, and a copy of the insurance card
Forms: Rx — legs · Rx — arms · measuring forms
Compression pumps (E0651 / E0652)
All notes and signed documents must be dated within the past 6 months.
- Face sheet with primary and secondary insurance (member ID and group number) and a copy of the insurance card, front and back
- Signed, dated progress notes with a lymphedema diagnosis (I89.0, I97.2 or Q82.0), a statement that it is chronic and persistent, and at least 4 weeks of failed conservative therapy — elevation, exercise, medical-grade compression, diet, and MLD if applicable
- Limb measurements with dates — at baseline and after the 4-week trial
- Signed Letter of Medical Necessity on letterhead, with the same rationale
- Signed addendum, if the progress notes don't include the required language
- Signed order (SWO) — HCPCS E0651 or E0652 plus two E0667 sleeves, frequency and duration of use, provider NPI and signature
- E0652 only: the physician must document why a calibrated pump is needed over E0651, specific to this patient. Listing “unique characteristics” without context will be denied.
Forms: pump Rx form · pump documentation guide
What happens next: we check the patient's benefits, tell your office right away if anything is missing, contact the patient to schedule a fitting or delivery, and keep you updated through Parachute or by fax. Want an update on a referral you already sent? Use the status form below.
Customer Support Team
Our CSRs handle every referral from intake to delivery. Call or text with questions about a patient, paperwork or an order.
- Phone
- 800-883-1549
- Text
- (517) 657-5223
- Fax
- 800-886-4201
- customersupport@midwestcompression.com
- Hours
- Mon–Wed 9–3 · Thu 9–5 · Fri 9–1 (Eastern)
Refer a patient
The steps, what to include and the forms to send.
Vein & wound care
Compression for CVI, varicose veins, venous ulcers and after vein procedures.
Compression pumps
The device we fit, the evidence behind it, and what an approval needs.
Garments & documentation
What the chart notes should show, measuring and replacement timing.
For your patients
Pages and handouts to share so patients know what to expect.
For your staff
Training for your team and help with day-to-day orders.
Downloads & forms
Forms, ordering guides and handouts
Everything to send a referral, order on Parachute, measure and size, and educate your patients.
Referral & Rx forms
Ordering on Parachute Health
Sizing & measuring
Clinical references & handouts
Get started
Send your first referral
Fax 800-886-4201, order through Parachute Health, or use our secure portal. Questions about a patient or a product? Call 800-883-1549 or email customersupport@midwestcompression.com.