How to Order

1. Complete JAS USA Product Order Form

There are two sheets to be completed for each JAS order, a patient information sheet, and a device measurement sheet (upper or lower extremity).

JAS order forms are available from your local JAS representative, or you can download PDF versions. The PDF versions have form fields that can be filled out electronically by tabbing through the documents. Once completed, the form can be emailed from the link on the document or by saving a copy to your computer and attaching it to an email.

JAS Common Measurement Guide

Refer to this JAS-provided guide on how to obtain optimal and accurate measurements for Upper and Lower Extremities.

Measurement Guides

2. Obtain Physicians’ Prescription or Certificate of Medical Necessity Form and Most Recent Chart Notes

A complete prescription should include the following: patient’s name, date of birth, diagnosis, device ordered, and duration of use (e.g. 1 to 5 months). Insurance companies, especially Medicare, have many different requirements for documentation, and the example CMN below may not meet all of them. JAS may need to request other documentation based on the patient’s insurance information.

3. Send Documents to JAS

Send order form, patient information sheet and measurement form, prescription or certificate of medical necessity, and chart notes to FAX 217-347-3384 or e-mail orders@jointactivesystems.com

Your order will be processed and shipped to the requested address once insurance benefits are obtained. JAS will handle all authorization and billing procedures. Your local JAS representative will contact you to arrange for a patient fitting appointment.

In order to comply with state or insurance regulations, JAS may need to route orders through a local licensed specialist. Contact your JAS representative for details or call our office, toll-free, at: 1-800-879-0117

If you have any questions or would like to speak to a JAS representative call our office, toll-free: 1-800-879-0117

1. Complete JAS International Product Order Form

There are two sheets to be completed for each JAS order, a patient information sheet, and a device measurement sheet (upper or lower extremity).

JAS order forms are available from your local JAS representative, or you can download PDF versions. The PDF versions have form fields that can be filled out electronically by tabbing through the documents. Once completed, the form can be emailed from the link on the document or by saving a copy to your computer and attaching it to an email.

JAS Common Measurement Guide

Refer to this JAS-provided guide on how to obtain optimal and accurate measurements for Upper and Lower Extremities.

Measurement Guides

2. Obtain Physicians’ Prescription or Certificate of Medical Necessity Form and Most Recent Chart Notes

A complete prescription should include the following: patient’s name, date of birth, diagnosis, device ordered, and duration of use (e.g. 1 to 5 months). Insurance companies, especially Medicare, have many different requirements for documentation, and the example CMN below may not meet all of them. JAS may need to request other documentation based on the patient’s insurance information.

3. Send Documents to JAS

Send order form, patient information sheet and measurement form, prescription or certificate of medical necessity, and chart notes to FAX 217-347-3384 or e-mail orders@jointactivesystems.com

Your order will be processed and shipped to the requested address once insurance benefits are obtained. JAS will handle all authorization and billing procedures. Your local JAS representative will contact you to arrange for a patient fitting appointment.

In order to comply with state or insurance regulations, JAS may need to route orders through a local licensed specialist. Contact your JAS representative for details or call our office, toll-free, at: 1-800-879-0117

If you have any questions or would like to speak to a JAS representative call our office, toll-free: 1-800-879-0117