For best results, in your print dialog, check “Shrink to Fit Page” if available, and turn off page headers and footers.
If you have issues printing this form, please download and use the PDF version.

Physician’s Written Order VeinOPlus Vascular

Physician Information


I certify that I am the physician identified on this form. I have reviewed the Physician’s Written Order. Any statement on my letterhead attached hereto has been reviewed and signed by me, I certify that the medical necessity information is true, accurate, and complete, to the best of my knowledge. I certify that the patient/caregiver is capable and has successfully completed training or will be trained on the proper use of the products prescribed on this Written Order. The patient’s record contains supporting documentation that substantiates theutilization and medical necessity of the products listed, and physician notes and other supporting documentation will be provided to VasoCARE, LLC upon request. I understand any falsification, omission or concealment of material fact in that section may subject me to civil or criminal liability. A copy of this order will be retained as part of the patient’s medical record.

Patient Information


    

Dispensing Instructions


Est length of need = 99 months
Perform one hour session x per day

Number of refills: 12

Medical Need / Diagnosis


Please check the diagnosis leading to Calf Muscle Pump Dysfunction:

** Contraindications: Wearers of cardiac pacemakers and/or defribrillators should not use the VeinOPlus


Please fax signed and dated PWO, Medical Records, and Face Sheet to:
VasoCARE @ 1-866-455-5150

The VeinOPlus Vascular device with Second Heart Technology...

  • Effectively treats calf muscle pump dysfunction (Griffin 2010)
  • Improves venous outflow 7 times (Griffin 2010)
  • Reduces edema 80% (Zuccarrelli 2005)
  • Stimulates neuropeptides (endorphines) and reduces pain by 80% (LeTohic 2009)
  • Lowers peripheral vascular resistance 30% (Griffin 2010)
  • Effective in reducing chronic venous edema (Bogachev 2011)
  • Increases arterial inflow 5 times (Abraham 2013)
  • Causes no significant oxygen consumption (Bieuzen 2012)
  • Causes no muscle ischemia (Bieuzen 2012)
  • No change in heart rate (Abraham 2013)
  • Prevents venous stasis/deep vein thrombosis (Griffin 2010)
  • EMS of calf muscle prevents post-op VTE (Lobastov 2014)
  • Efficacy in the treatment of patients with shin bone fractures (Obolenskiy 2014)
  • Accelerates healing of venous ulcers 3 times (Bogachev 2015)
  • Improves walking distance for claudicants (Ellul 2017)
  • Improves TcPO2 levels and accelerates the healing of vascular ulcers (Beliard 2018)
  • Prevents recurrence DVT in patients with PTS and RVO (Lobastov 2018)

The above represents a listing of VeinOPlus studies, principal physician, and date of publication.

Treatment Protocol with VeinOPlus Vascular

  • 4, one hour sessions/day for venous stasis ulcers
  • 4, one hour sessions/day for diabetic foot ulcers
  • 2, one hour sessions/day for chronic edema and/or PTS
  • 2, one hour sessions/day for intermittent claudication limb pain

Contraindication: Pacemaker/Defibrillator

Calf muscle contractions induced by VeinOPlus are well tolerated by patients with chronic edema, claudication limb pain, and ulcerations. No ischemic pain, no change in heart rate, and no risk of excessive use.

More stimulation with VeinOPlus produces better results!

P.O. Box 14933 l Baton Rouge, LA 70898

PHONE: 800-256-9979 FAX: 866-455-5150

© 2019-Present by VasoCARE, LLC. All rights reserved by VasoCARE.
vasocare.com

For best results, in your print dialog, check “Shrink to Fit Page” if available, and turn off page headers and footers.
If you have issues printing this form, please download and use the PDF version.