Afflovest Order Form. Web by providing this form to an authorized afflovest distributor, i acknowledge that the patient is aware that he or she may be contacted by said distributor for any additional information to process this order. Physician signature (no signature stamp) date
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Once your healthcare team has decided afflovest is the airway clearance therapy for you, they can fill out the afflovest order form, provide all necessary insurance and medical documentation and contact a dme distributor to place the afflovest order. Web request more information about afflovest. Web by providing this form to an authorized afflovest distributor, i acknowledge that the patient is aware that he or she may be contacted by said distributor for any additional information to process this order. The afflovest has received the fda’s 510k clearance for u.s. Market availability, and is approved for medicare, medicaid, and private health insurance reimbursement. Please answer all questions to the best of your ability so we can provide you with the most comprehensive information about afflovest. Web standard written order: Web physicians order that includes: Leaving blank presumes lifetime (99 months) 3. Send us your information and a representative will reach out as soon.
Find out how afflovest, the first portable, fully mobile during use hfcwo vest, can help patients with cystic fibrosis clear their airways and mobilize lung secretions. Physician signature (no signature stamp) date Web standard written order: Web by providing this form to an authorized afflovest distributor, i acknowledge that the patient is aware that he or she may be contacted by said distributor for any additional information to process this order. Leaving blank presumes lifetime (99 months) 3. Web this form to an authorized afflovest distributor, i acknowledge that the patient is aware that he or she may be contacted by said distributor for any additional information to process this order. Once your healthcare team has decided afflovest is the airway clearance therapy for you, they can fill out the afflovest order form, provide all necessary insurance and medical documentation and contact a dme distributor to place the afflovest order. Web request more information about afflovest. Send us your information and a representative will reach out as soon. Fill out the form below to receive emails and literature in the mail containing more information about afflovest mobile mechanical hfcwo airway clearance therapy. Web physicians order that includes:
