To order a LifeVest, you have the choice of using the Medical Order form, placing a chart order, or placing a verbal order. In each case, documentation must be provided to support the diagnosis and medical necessity of the LifeVest. Specific instructions are provided below.
To place a Medical Order
Complete the Medical Order and fax it to ZOLL. Click on the link below to download the form and instructions.
Medical Order Form and Instructions
ICD-9 Codes for Selected Cardiac Diagnoses
Fax Cover Page
To place a chart order
Specific information must be provided. Click on the link below for instructions.
Chart Order Instructions Pocket Card
To place a verbal order
Specific information must be provided. Click on the link below for instructions.
Verbal Order Instructions