• Referring Therapist Information

  • Patient Information

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  • If this information can't be uploaded now, please either fax it to
    (615) 807-3334 or email it to referrals@compressioncare.com.

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  • Referring Physician Information

  • DAY GRADIENT COMPRESSION GARMENTS

  • GRADIENT NIGHT COMPRESSION GARMENTS - NON-ELASTIC SUPPORT GARMENT

  • Night Garment with Foam Core / Channeled Style for Compression

  • VELCRO WRAPS

  • OTHER GARMENTS

  • Treatment Plan: The treatment plan for this prescription is for compression garments to be worn during day and/or night on a daily basis as prescribed by the physician. 

    Certification of Medical Need: The medical equipment herein prescribed is medically necessary to heal and to prevent ulcers/wounds and to contain lymphedema, to prevent ulcers/infection/celluitis and/or to decrease pain and/or to increase blood flow using gradient pressure. 

  •  DAY GRADIENT COMPRESSION GARMENTS

  • GRADIENT COMPRESSION WRAPS - NON ELASTIC SUPPORT GARMENT

  • GRADIENT COMPRESSION GARMENT - NON ELASTIC SUPPORT GARMENT

  • Should be Empty: