For Domestic U.S. Sales
1. Complete JAS USA Product Order and Measurement Forms
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 below. The PDF versions have form fields that can be filled out electronically by tabbing through the documents.
Video 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 email@example.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
For International Sales Outside the U.S.
Contact JAS International Sales Department
For product pricing and assistance in placing an order for JAS GL and JAS ADVANCE Dynamic products from outside of the United States, contact our international sales department at email: firstname.lastname@example.org or call: 217-342-3412 extension 4701.
The JAS international sales department with either direct you to a local distributor, or will guide you through the rest of the order process.
For your convenience, JAS GL and JAS ADVANCE DYNAMIC ROM order forms are available below. The PDF versions have form fields that can be filled out electronically by tabbing through the documents.