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 Gulf Coast Compression at 800-886-4201, at which point Gulf Coast Compression will seek to obtain authorization from the patient's medical insurance provider (if necessary).
Once authorization is obtained (wherever applicable), Gulf Coast 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.
Gulf Coast 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 Gulf Compression Referral Form
Compression Pump Referral Form: PDF
Click the links below to view DVT Pump Referral Instructions and DVT Referral Form.
(FAX TO: 800-886-4201)
For other patient documents/forms please visit our document center below