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To order a JAS device, just follow these simple steps:
A PDF form is available.. This PDF has form fields that can be filled out electronically by tabbing through the document. After 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. Download the interactive/emailable form here.... Order Form PDF.
**Note** The functionality of this form is dependent on the configuration of your computer. For this reason, it is recommended to download the form and attach it manually. Print more detailed instrucitons here .... Instructions Requirements: Acrobat Reader (version 8 is recommended - download link provided below) Internet Explorer Version 6.0 or higher (other web browers may be incompatible) E-mail orders to orders@jointactivesystems.com Include a physician’s prescription or
completed statement of medical necessity form (download below) if
available. 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).
Fax orders and other documents to 217-347-3384.
Statement of Medical Necessity: PDF - MicrosoftWord
Order Form: (Devices indicted on form in lower left corner)
(Note - This form is not formatted to be filled out electronically. Print copy only.) Order Form
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