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Compression Stockings PRESCRIPTION FORM Vascular &Interventional Radiology Clinic

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Compression Stockings PRESCRIPTION FORM Vascular &Interventional Radiology Clinic Patient Label ! ! ! Compression Stockings PRESCRIPTION FORM Vascular &Interventional Radiology Clinic 701 E. EL CAMINO REAL 3RD FLOOR, MOUNTAIN VIEW, CA, 94040 | P: 650.404.8445 | F: 650.404.8447 ! DIAGNOSIS : ______________________________________________ ICD9 : ___________________ DATE: ____________________ ! Number of Pairs Number of Refills ! COMPRESSION: ⎕ 15-20 mmHg ⎕ 40-50 mmHg ! ⎕ 20-30 mmHg ⎕ 50-60 mmHg ! ⎕ 30-40 mmHg STYLE: ⎕ calf ⎕ thigh ⎕ pantyhose ⎕ thigh w/ waist ⎕ plus size !PHYSICIAN SIGNATURE: ____________________________ DATE: _______________________ ⎕ Fabio Komlos, MD ⎕ Bart Dolmatch, MD ! It is the patient’s responsibility to contact their insurance company for benefit information. Please call the number in the back of your insurance card to find out if compression garments are a benefit of membership. Thank you. ! Compression Stocking Instructions ! A prescription is needed for a stocking with compression pressure >15 mmHg. A fit measurement is usually done at the medical supply stores where you purchase your stockings. It is recommended to take your measurements in the morning before swelling builds in the legs to avoid choosing a stocking size that is too large. If compression stocking is covered by the insurance, you usually pay ahead and the medical supply store will give you a receipt, which you can mail to your insurance for reimbursement. The stockings can be knee-high or thigh-high. The correctly fitted stockings will not cut off your circulation. They help with the discoloration condition called postphlebitic syndrome and they help to prevent clot formation in your legs, especially if you have a long air flight or are not able ambulate for long periods of time. The durability of the stockings varies from manufacture to manufacture. Generally, they last for 4-6 months. If possible, have 2 pairs available so you can wear one while the other one is in the wash. The length of time for compression stockings depends on both the reason for wearing the compression and the amount of compression. Check with your doctor for instructions. In general you should put the compression stockings in the morning before the swelling builds up. You should take them off before sleeping. We do not recommend sleeping with the compression stockings. Proper compression stockings should feel snug at first. It will take a few days to adjust to the pressure. ! TIPS FOR PUTTING ON YOUR COMPRESSION STOCKINGS: ! • Compression garments are easier to put on when you • grasp the stocking at both sides of the top band first get out of bed, before swelling occurs. • Pull onto foot and up the leg as far as possible • Skin should be dry • Choose a position on the leg where you can grasp • Applying a thin layer of cornstarch or powder will help the stocking on both sides again and pull up as far the stockings or sleeve slide over your skin as possible. Fold the excess fabric back down onto your leg rather than allowing it to bunch or roll • Remove any rings and jewelry that can damage your stockings • Grasp the stocking at the top and pull out the fold • Can wear gloves to prevent fingernails from damaging • Repeat until heel is in place the fabric - they also help provide grip to distribute the fabric more easily • Avoid rolling, gathering or bunching the fabric, as this will only increase the pressure – like creating a super rubber band. • Apply moisturizer to your legs or arm in the evening rather than just before putting on your stocking or sleeve in the morning. • PULL ON METHOD ! List of Compression Stockings Distributors* outpatient MOUNTAIN VIEW: SAN JOSE: CAMINO PHARMACY SANTA CLARA OSTOMY AND MEDICAL 701 E. El Camino Real - 2nd floor 2455 Forest Ave P: 650.934.7699 P: 408.296.7890 ! ! NOREL PROSTHETICS BISCHOFF’S MEDICAL SUPPLY 205 South Drive 225 North Bascom Ave P: 650.968.7464 P: 408.286-6651 ! ! PALO ALTO: SANTA CRUZ: PALO ALTO ORTHOPEDIC HORSNYDER PHARMACY 3910 Middlefield rd 1226 A Soquel Ave P: 650.813.9300 P: 831.423.2315 ! ! FREMONT: SAN FRANCISCO: HALLERS PHARMACY BISCHOFF’S MEDICAL SUPPLY 37323 Fremont Blvd 1635 Divisadero st. #105 Freemont, CA P: 415.921.0440 ! P: 510.797.2772 For additional information in your area www.sigvaris.us/find www.supporthosestore.com www.jobst-usa.com www.ameswalker.com www.footsmart.com www.supportplus.com ! *The vascular and interventional radiology clinic has no financial interest or relanshionship with any of these stores or websites..
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