Two distinct product pathways help you direct patients to the right conversation. Lymphedema referrals are not limited to breast cancer care.
Discuss a referralFor clinician-directed compression products, including referrals from vascular and wound-care physicians, primary care, rehabilitation, and oncology.
A separate product conversation for patients after breast surgery, with the surgical team guiding garment timing and recovery requirements.
Call our team to confirm current product options and the appropriate secure method for sending a referral. Do not send patient records through a general website contact form.
Contact & referral instructionsLymphedema & Compression or Mastectomy Care, with the requested product category.
Ask about the prescription, clinical documentation, product details, and payer-specific requirements.
Confirm the approved referral channel with our team before sending patient information.
For physician completion.
One selected device code per worksheet.
Identify the prescribed device, compatible garments, and device-specific instructions needed for the order.
Document the clinical assessment and provide a place for the physician to state whether the patient is able and willing to use the prescribed device.
These are Befitting You workflow requirements. Coverage criteria, supporting records, and payer rules must also be verified. This worksheet does not establish medical necessity or guarantee coverage.
FOR CLINICIAN COMPLETION
No information is sent or saved by this worksheet. Please print the blank worksheet for your clinician to complete by hand. Do not enter patient or medical information on this website.
Select the code directed by your clinician or supplier. This tool does not determine code eligibility or make diagnostic recommendations.
Payer requirements vary. This is a supporting worksheet, not complete coverage criteria or a coverage guarantee. The physician must complete the evaluation, including any statements about device use.
View pump coverage & authorization guidanceBlank worksheet preview — patient and clinical details are completed on paper, never online.
