1st Line Medical accepts all forms of prescriptions submitted by Fax to 800-918-7860
The form below can be downloaded for order fulfillment and contains the required ICD-10 for indication as well as HCPCS code for the patient to reference with they insurer for potential insurance reimbursement.
A Secure Online Portal is also available for uploading PDF.
Please contact customer service at 866-720-8080 with any questions or to verbally submit a prescription,
email: [email protected] or complete the
secure patient prescription information using the patient submission form below.
You may also contact
The form below can be downloaded for order fulfillment and contains the required ICD-10 for indication as well as HCPCS code for the patient to reference with they insurer for potential insurance reimbursement.
A Secure Online Portal is also available for uploading PDF.
Please contact customer service at 866-720-8080 with any questions or to verbally submit a prescription,
email: [email protected] or complete the
secure patient prescription information using the patient submission form below.
You may also contact
| SomnoGuard Master Rx Form.pdf |