SUBMIT NMES – TENS UNITS PRESCRIPTION

Requirements for submitting prescription

Please include the following:

1. Face Sheet / Demographics – For patient (from practice’s EHR / EMR or files). Please fax or attach to DME order.
2. Medical Records / Chart Notes (from practice’s EHR / EMR or files). Please fax or attach to DME order.
3. Fill out Patient form
4. Fill out Physician form