How to Order JAS Products
To order a JAS device, just follow these simple steps:
Step 1. Complete JAS Order 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. 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.
Patient Information Form
Upper Extremity Measurement Form
Shoulder Measurement Form
Lower Extremity Measurement Form
**Note** The functionality of this form is dependent on the configuration of your computer and these files can take a while to download and display. For this reason, it is recommended to download the form and attach it to an e-mail manually.
Acrobat Reader (version 8 is recommended)
Internet Explorer (version 6.0 or higher is recommended)
Step 2. Obtain Physicians Prescription or Statement 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).
Statement of Medical Necessity
Step 3. Send Documents to JAS. Send order form, patient information sheet and measurement form, prescription, 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