RESOURCES
Provider Forms And Documents
Everything a practice or prosthetics department needs to prescribe, order, and get started with Encora X1. All files are PDFs, ready to download, print, or share.
PRESCRIBING AND COVERAGE
Medicare, Commercial Insurance, And Self-Pay
Prescriber checklists, prescription form, insurance, and signed agreement together.
Prescription Submission Quick Start
What to send, where to send it, and the contacts for each step.
RX-001 REV 3 · 2 PAGES
Assignment of Benefits
Patient signature page assigning benefits and authorizing release of information.
RX-004 REV 3 · 1 PAGE
BF-ADL Assessment
Bain & Findley scale used to establish baseline and document improvement.
RX-005 REV 2 · 1 PAGE
Standard Written Order
The prescription form for Medicare, commercial insurance, and self-pay patients.
RX-003 REV4 · 1 PAGE
Insurance Coverage Checklist
Documentation required at initial coverage and at the 60-to-91-day Medicare re-evaluation.
RX-002 REV 4 · 2 PAGES
Wrist Measurement Guide
How to measure a wrist and select the band size, with a printable measuring strip.
RX-009 REV 1 · 2 PAGESVETERANS HEALTH ADMINISTRATION
VA And Federal
Federal procurement supported by Lovell Government Services. Resources cover prescribing, product fulfillment, sizing, and VA ordering support.
VA Provider Quick-Start
Clinical and product guidance from patient evaluation through VA submission, including suggested PSAS consult language.
RX-006 REV 4 · 2 PAGES
Optional Encora X1 Prescription Form
Optional form to capture the product and patient information needed to fulfill Encora X1. VA facilities may use their own documentation.
RX-007 REV 5 · 1 PAGEWrist Measurement Guide
How to measure a wrist and select the band size, with a printable measuring strip.
RX-009 REV 1 · 2 PAGES
VA Prosthetics Product & Fulfillment Guide
Encora X1 product, fulfillment, sizing, bilateral prescribing, replacement, and support information for VA Prosthetics teams.
RX-011 REV 0 · 2 PAGESEVIDENCE AND PRODUCT INFORMATION
Product and Clinical
Learn more about Encora X1 clinical trial data, get the operating detail you need before a first prescription, and leave something in the waiting room for patients still deciding.
COMING SOON
Instructions for Use
Complete indications, contraindications, warnings, precautions, and operating instructions.
RX-001 REV 3 · 2 PAGES
Clinical Evidence One-Pager
Two-page summary of responder rates, safety, and study design.
MKT_002 REV 1 · 2 PAGES
Clinical Evidence Whitepaper
Full ULTRE and 90-Day Home Use study results, methods, and endpoints.
MKT-001 REV 0 · 1 PAGE
Patient Brochure
Eight-page introduction for patients and caregivers, written for the waiting room.
MT-003 REV 2 · 8 PAGESWEB-021 REV0