At QAS, we strive to provide the tools that you need for effective management of INR testing. Due to demand, we have created easy to use patient forms for INR self-testing. You can complete the prescription form, letter of medical necessity and patient information sheet and print them directly from the website.
- STEP 1
Click one of the links below to begin downloading the form. When the form opens click in the various fields to enter your patient information. A cursor will appear and you can key in the information; then press tab to go to the next entry field.
- STEP 2
After you complete each form, print it for the physician and patient signatures. To ensure a timely result for everyone, please make sure the forms are complete.
- STEP 3
You can fax the forms to your QAS representative or to our main fax line 407-563-2861.
Thank you for your interest and do not hesitate to
contact us with any questions.
| How can I get a ProTime Microcoagulation System? |
Home Test Medical (Division of QAS, Inc.) is a company
dedicated to helping you successfully participate in your own healthcare through self testing. |
Getting started is easy! Here's how it works: |
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Step 1: |
We provide information to you and your doctor to help you decide if you are a good candidate
for self testing. If you and your physician decide that you are a good candidate he/she will
fill out and forward a prescription and if you intend for us to apply to your insurance
company for payment, a letter of medical necessity. Note: We will provide forms and examples
for your physician to use via mail or you can download forms and print right now.
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Step 2: |
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After we receive your prescription and letter from your doctor, our insurance specialists
will pursue coverage for you. If you do not wish to wait for the sometimes lengthy insurance
approval process, we accept all major credit cards and can work out a payment plan or lease.
If we have verified your insurance coverage and you elect to purchase your ProTime® outright,
we guarantee you will receive coverage (amount of coverage varies based upon insurance policy)
and if you do not, you may return the instrument for a refund* within twelve months of your ProTime Monitor purchase.
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Step 3: |
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Next, we provide training and fast, efficient product delivery nationwide. Our
knowledgeable and friendly staff including nurse trainers, pharmacists and patient
service specialists, backed by manufacturer technical support, provide you with
ongoing assistance.
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* - Restocking fee may apply on instrument returns. Supplies are non-refundable.