The Home Phototherapy Prescription and Written Order Form (download above) includes a dosing order to provide a convenient method to communicate treatment insructions or guidance.  You may choose to follow Daavlin's standard treatment protocols based on 35+ years of experience, or provide your own custom treatment regimen.  If you have questions or have a patient with treatment challenges, please contact us.
Prescribing Home Phototherapy
Dosing
Typically there are three documents that are needed to order home phototherapy equipment:
Often there are two or more phototherapy device models that will treat each patient's condition.  Due to phototherapy device reimbursement categories at the insurance companies, choosing the model with the best reimbursement can save the patient considerable out-of-pocket expense.  Dermitech is available to work with you to help choose the optimum treatment device with the best value for the patient.  Below is a product selection guide that also may be used to help choose the best model for the patient.
Product Selection:
2.  Prescription or Prescription and Written Order Form:  The Prescription and Written Order Form serves the purpose of a prescription and provides additional information insurance payors need to determine medical necessity.  If a written prescription is used, it must state the lamp type (e.g. Narrowband UVB).
Letter of Medical Necessity:  If a written prescription is used in lieu of the Prescription and Written Order Form, the insurance payors usually require an accompanying letter or statement of medical necessity.  It should be printed on official stationary or letterhead and signed by the prescribing physician.  Below is a sample in Microsoft Word that can be edited by the prescriber as necessary.
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1.  Patient Order Form:  This is filled out by the patient, sometimes with help from the prescriber.  The product type may be left blank if guidance from Dermitech is needed to help pick the best product based on the patient's insurance situation.
For most home phototherapy products, you can choose a timer controller or dosimetry controller.  A timer controller provides the treatment "dose" based only on time of exposure.  While this is the most common and most economical option, it does not account for warm-up time of the lamps, lamp age, and other factors.  A dosimetry controller measures the actual energy output of the phototherapy device and adjusts the treatment time to provide a precise dose.  Note that the precision that dosimetry offers is usually not necessary so in most cases a timer controller is adequate, but both options are offered.
Timer vs. Dosimetry Control
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Patient Instructions and Treatment Log:
The patient instructions form provides the patient with the starting dose, dose increases, and other important information regarding their treatment.  The treatment log helps you and the patient keep track of past treatments to help determine if treatment adjustments are needed.
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3.  Chart Notes:  Insurance payors usually require accompanying 5-10 pages of chart notes to further establish medical neccesity.
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Providers Page for Home Phototherapy
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