Designed by Paula D. Estridge Director of Corporate Supply Bird and

Bear Medical, Inc.

Incontinence & Diabetic Products for

the Aging

Choosing the Proper Products and Getting them Paid for by Medicaid and

other Insurances

HOW TO TALK COMFORTABLY HOW TO TALK COMFORTABLY WITH YOUR INCONTINENCE WITH YOUR INCONTINENCE

CLIENTSCLIENTSYou are providing your clients a very valuable You are providing your clients a very valuable

service if you can help them live a more full life service if you can help them live a more full life by managing their incontinence. Here are a by managing their incontinence. Here are a few tips to help bring up the conversation in a few tips to help bring up the conversation in a comfortable way for your clients:comfortable way for your clients:

““Bladder Leakage”: Use terms like this to Bladder Leakage”: Use terms like this to describe incontinence or ask if they wear pads describe incontinence or ask if they wear pads for urine leakage. Incontinence is not a word for urine leakage. Incontinence is not a word everyone is familiar with or comfortable using.everyone is familiar with or comfortable using.

They are not alone: Assure your client that They are not alone: Assure your client that incontinence is not a disease but it does impact incontinence is not a disease but it does impact many people; over 25 million in the U.S. alone.many people; over 25 million in the U.S. alone.

Facts about Bladder Facts about Bladder LeakageLeakage• Affects up to 25 million Americans each yearAffects up to 25 million Americans each year

• 15% of men over 65 experience bladder leakage15% of men over 65 experience bladder leakage• Over 80% of those who are incontinent are womenOver 80% of those who are incontinent are women• It is not a disease, it is a symptom with many causes. It is not a disease, it is a symptom with many causes. Some causes areSome causes are: : • job related activity like heavy liftingjob related activity like heavy lifting• high impact activitieshigh impact activities• lung disease due to chronic coughinglung disease due to chronic coughing• certain foods/beveragescertain foods/beverages• poor nutritionpoor nutrition• constipationconstipation• anatomical predispositionanatomical predisposition• obesityobesity• previous urinary tract or renal problemsprevious urinary tract or renal problems• loss of pelvic muscle toneloss of pelvic muscle tone• pregnancy & childbirthpregnancy & childbirth• menopausemenopause• pelvic surgery or traumapelvic surgery or trauma• neuromuscular or cognitive impairmentsneuromuscular or cognitive impairments• medication side effects and the use of diuretics.medication side effects and the use of diuretics.

There are Six Different There are Six Different Types of IncontinenceTypes of Incontinence

• Stress IncontinenceStress Incontinence: Leakage if you laugh, : Leakage if you laugh, sneeze, or exercise: involuntary loss of a few sneeze, or exercise: involuntary loss of a few drops, most common in women, usually occurs drops, most common in women, usually occurs with a laugh, cough, sneeze, or exertion. with a laugh, cough, sneeze, or exertion. Common causes: Pregnancy & Childbirth, pelvic Common causes: Pregnancy & Childbirth, pelvic surgery or trauma, obesity or weak pelvic surgery or trauma, obesity or weak pelvic muscles.muscles.

• Urge IncontinenceUrge Incontinence: Can’t get to the bathroom : Can’t get to the bathroom on time: awareness of the need to go, frequent, on time: awareness of the need to go, frequent, strong & sudden urges but cannot always make strong & sudden urges but cannot always make it to the bathroom on time. Common causes: it to the bathroom on time. Common causes: Bladder irritants, urinary tract infections, or Bladder irritants, urinary tract infections, or tumors and stones.tumors and stones.

6 Types of Incontinence 6 Types of Incontinence continuedcontinued

• Reflex IncontinenceReflex Incontinence: Urine loss with no warning. : Urine loss with no warning. Can not tell they need to go. Common Causes: Can not tell they need to go. Common Causes: Stroke, brain tumors, or spinal cord injuries.Stroke, brain tumors, or spinal cord injuries.

• Overflow IncontinenceOverflow Incontinence: Bladder too full. : Bladder too full. Leakage when the bladder reaches a level of Leakage when the bladder reaches a level of fullness, often accompanied by dribbling, fullness, often accompanied by dribbling, frequency & urgency of urination increases. frequency & urgency of urination increases. Common Causes: Medications, urethral Common Causes: Medications, urethral obstruction, neurological conditions, or benign obstruction, neurological conditions, or benign prostatic hyperplasia (BPH). (BPH is a non-prostatic hyperplasia (BPH). (BPH is a non-malignant enlargement of the prostate gland malignant enlargement of the prostate gland occurring in men after the age of 50, and occurring in men after the age of 50, and sometimes leads to compression of the urethra sometimes leads to compression of the urethra and obstructions of the flow of urine.)and obstructions of the flow of urine.)

6 types of Incontinence 6 types of Incontinence continuedcontinued

• Functional IncontinenceFunctional Incontinence: A barrier when : A barrier when getting to the bathroom. Immobility or getting to the bathroom. Immobility or cognitive impairment hinders ability to get to cognitive impairment hinders ability to get to the toilet, person may be a fall risk or the toilet, person may be a fall risk or bathroom may be inaccessible. Common bathroom may be inaccessible. Common causes: Cognitive impairment, functional causes: Cognitive impairment, functional disability, psychological impairment, or disability, psychological impairment, or environmental barriers.environmental barriers.

• Mixed IncontinenceMixed Incontinence: A combination of two or : A combination of two or more types. Symptoms can include a more types. Symptoms can include a combination of the other types of incontinence.combination of the other types of incontinence.

Managing IncontinenceManaging IncontinenceBehavioral Behavioral

TherapyTherapyDiet Diet

ModificatioModificationn

MedicationMedication SurgerySurgery IncontinenIncontinence ce

ProductsProductsBehavior Therapy Behavior Therapy involves involves understanding understanding your body.your body.

Certain foods act Certain foods act as diuretics and as diuretics and may be removed may be removed from the diet.from the diet.

Certain Certain medications for medications for unrelated issues unrelated issues can trigger can trigger incontinence.incontinence.

All surgery must All surgery must be considered be considered carefully. carefully.

Assess for the Assess for the proper product proper product needs based on needs based on the type of the type of incontinence the incontinence the client has.client has.

You may create You may create toileting toileting schedules to schedules to proactively visit proactively visit the bathroomthe bathroom

Eliminating one or Eliminating one or all of the foods all of the foods may improve your may improve your urine control.urine control.

Look into Look into medications that medications that are bladder are bladder irritants.irritants.

Surgery comes Surgery comes with risks and with risks and potential potential complications.complications.

Patients may need Patients may need a variety of a variety of products. For products. For example, example, pantyliners or pantyliners or pullups during the pullups during the day and diapers at day and diapers at night.night.

Use a diary to Use a diary to create a schedule create a schedule & discuss with & discuss with your physician.your physician.

Look into foods & Look into foods & beverages that beverages that are bladder are bladder irritants.irritants.

Other medications Other medications can help treat can help treat bowel/fecal bowel/fecal incontinence. incontinence. Discuss with MD.Discuss with MD.

Talk to the MD.Talk to the MD.

For women: Kegal For women: Kegal exercises are also exercises are also sometimes sometimes recommended to recommended to strengthen the strengthen the pelvic muscles.pelvic muscles.

Choosing the right Choosing the right productproduct

Types of Types of ProductsProducts

Information on Information on ProductProduct

StressStress UrgeUrge OverfloOverfloww

FunctioFunctionalnal

ReflexReflex

Bladder Control Bladder Control PadsPads (pantyliners, (pantyliners, pads or male pads or male guards)guards)

•Available in a Available in a variety of sizes and variety of sizes and

absorbenciesabsorbencies•Individually Individually wrapped for wrapped for

discretion and discretion and convenienceconvenience

XX XX XX

Belted ShieldsBelted Shields (belted (belted undergarments or undergarments or open sided belted open sided belted pads)pads)

•One size fits mostOne size fits most•Reusable elastic Reusable elastic

strapsstraps•Reinforced Reinforced buttonholesbuttonholes

XX XX XXProtective Protective UnderwearUnderwear

(pullups, DPU, (pullups, DPU, briefs, overnight briefs, overnight pants)pants)

SIZED BY HIP SIZED BY HIP SIZESIZE

•Pull on & off like Pull on & off like regular underwearregular underwear

•Available in a Available in a variety of sizes, variety of sizes,

styles & styles & absorbenciesabsorbencies

XX XX XX

Adult BriefsAdult Briefs

(diapers)(diapers)

SIZED BY SIZED BY WAISTWAIST SIZESIZE

•Ideal for heavy & Ideal for heavy & fecal incontinence fecal incontinence

protectionprotection•Available in a Available in a

variety of sizes & variety of sizes & absorbenciesabsorbencies

XX XXUnderpadsUnderpads

(Chux, bed pads)(Chux, bed pads)

•Placed under Placed under client in bed/chairclient in bed/chair

•Protects when Protects when leakage may occurleakage may occur

XX XX XX XX XX

Food & Beverages that Food & Beverages that affect Incontinenceaffect Incontinence

Common Bladder Common Bladder IrritantsIrritants

• Alcoholic Beverages: beer, wine, Alcoholic Beverages: beer, wine, liquor in any form are dehydratingliquor in any form are dehydrating

• Carbonated BeveragesCarbonated Beverages• Soft Drinks with CaffeineSoft Drinks with Caffeine• Coffee (Caffeine stimulates the Coffee (Caffeine stimulates the

bladder.)bladder.)• TeaTea• HoneyHoney• SugarSugar• Artificial SweetenerArtificial Sweetener• Corn SyrupCorn Syrup• ChocolateChocolate• Tomatoes (these are acidic)Tomatoes (these are acidic)• Citrus Fruits & JuicesCitrus Fruits & Juices

Helpful Foods & Helpful Foods & BeveragesBeverages

• Fiber: Found in oat bran, applesauce, Fiber: Found in oat bran, applesauce, prune juice, and in the form of additives, prune juice, and in the form of additives, can improve bowel habits and help ease can improve bowel habits and help ease constipation which can lead to constipation which can lead to incontinence.incontinence.

• Grape, cranberry, cherry and apple juice Grape, cranberry, cherry and apple juice are thirst-quenchers that usually are not are thirst-quenchers that usually are not irritating. irritating.

• Water: the best beverage of choice.Water: the best beverage of choice.

Important Note on LiquidsImportant Note on Liquids Many people who have bladder control issues Many people who have bladder control issues

reduce the amount of liquids they drink thinking reduce the amount of liquids they drink thinking that will help. This only causes more that will help. This only causes more concentrated urine (dark yellow, strong concentrated urine (dark yellow, strong smelling). This can irritate the bladder and smelling). This can irritate the bladder and increase the potential for a urinary tract increase the potential for a urinary tract infection and more incontinence. infection and more incontinence.

Medications that affect Medications that affect IncontinenceIncontinence

MedicationsMedications EffectEffect Bladder Bladder SymptomsSymptoms

Diuretics (water pills): Hydrodiuril Diuretics (water pills): Hydrodiuril (HCTZ), Lasix (furosemide), Maxzide (HCTZ), Lasix (furosemide), Maxzide (HCTZ-triamterene)(HCTZ-triamterene)

More urine More urine is producedis produced

Frequency, urgency, increased Frequency, urgency, increased amount of urine outputamount of urine output

Sedatives, muscle relaxants: Valium Sedatives, muscle relaxants: Valium (diazepam), Librium (diazepam), Librium (chlordiazepoxide), Ativan (lorazepam)(chlordiazepoxide), Ativan (lorazepam)

Sedation Sedation and and drowsinessdrowsiness

Possible lack of appreciation of Possible lack of appreciation of bladder eventsbladder events

Antihistamine: Benadryl Antihistamine: Benadryl (diphenhydramine)(diphenhydramine)

Antipsychotics/Antidepressants: Elavil Antipsychotics/Antidepressants: Elavil (amtriptyline), Prolixin (fluphenazine), (amtriptyline), Prolixin (fluphenazine), Haldo (haloperidol), Prozac (fluoxetine Haldo (haloperidol), Prozac (fluoxetine HCl)HCl)

Calcium channel blockers: Calan Calcium channel blockers: Calan (verapamil), Procardia (nifedipine), (verapamil), Procardia (nifedipine), Cardizem (diltiazem)Cardizem (diltiazem)

Retention of Retention of urine urine because the because the bladder is bladder is relaxed or relaxed or bladder bladder outlet outlet resistance is resistance is increasedincreased

Difficulty in starting the urinary Difficulty in starting the urinary stream, straining to void, voiding stream, straining to void, voiding with a weak stream, leaking in with a weak stream, leaking in between urinations, frequency, between urinations, frequency, urinary retentionurinary retention

Anticholinergics: Oxybutynin, Anticholinergics: Oxybutynin, tolterodine tartrate, trospium chloridetolterodine tartrate, trospium chloride

Possible Possible difficulty in difficulty in passing passing urine due to urine due to relaxation of relaxation of bladder bladder musclemuscle

Possible decrease in bladder Possible decrease in bladder emptying; rarely urinary emptying; rarely urinary retention, overflow incontinenceretention, overflow incontinence

Alpha adrenergic agonist: Entex, Alpha adrenergic agonist: Entex, Sudafed (pseudoephedrine)Sudafed (pseudoephedrine)

Increases Increases the the resistance of resistance of the bladder the bladder outlet outlet musclemuscle

Urinary retention, difficulty in Urinary retention, difficulty in starting the urinary stream, starting the urinary stream, straining to void, voiding with a straining to void, voiding with a weak stream, leaking between weak stream, leaking between urinations, frequencyurinations, frequency

Medications that affect Medications that affect continuedcontinued

MedicationsMedications EffectEffect Bladder Bladder SymptomsSymptoms

Over-the-counter cold Over-the-counter cold remedies: Nyquil, Theraflu, remedies: Nyquil, Theraflu, Alka Seltzer Plus Cold Relief, Alka Seltzer Plus Cold Relief, Afrin, long-acting nose dropsAfrin, long-acting nose drops

Retention of urine (Either Retention of urine (Either because the bladder is because the bladder is relaxed or the strength of relaxed or the strength of the bladder outlet muscle is the bladder outlet muscle is increased, depending on increased, depending on the particular medication)the particular medication)

Urinary retention, difficulty Urinary retention, difficulty in starting the urinary in starting the urinary stream, straining to void, stream, straining to void, voiding with a weak stream, voiding with a weak stream, leaking between urinations, leaking between urinations, frequencyfrequency

Alpha adrenergic Alpha adrenergic antangonist: Hytrin antangonist: Hytrin (terazosin), Cardura (terazosin), Cardura (doxazosin), Flomax (doxazosin), Flomax (tamsulosin)(tamsulosin)

Relaxes the bladder outlet Relaxes the bladder outlet musclemuscle

Leaking when coughing, Leaking when coughing, sneezing, laughing, sneezing, laughing, exercising, etc.exercising, etc.

DDAVP (desmopressin DDAVP (desmopressin acetate)acetate)

Decreases urine output Decreases urine output made by the kidneysmade by the kidneys

Possible decrease in blood Possible decrease in blood levels of salts. Decreased levels of salts. Decreased urine production.urine production.

Troubleshooting Guide for Troubleshooting Guide for ProductsProducts

LeakageLeakage:: Is the client in the proper product?Is the client in the proper product? Is the client in the proper size for their height and weight. Briefs too Is the client in the proper size for their height and weight. Briefs too

large will leak and sag.large will leak and sag. Is the product making contact with the body? It should be a snug fit.Is the product making contact with the body? It should be a snug fit. For briefs, are the bottom tabs angled up to cup the buttocks?For briefs, are the bottom tabs angled up to cup the buttocks? For briefs, are the top tabs angled at a downward angle for a snug fit at For briefs, are the top tabs angled at a downward angle for a snug fit at

the waist?the waist? Are barrier creams being used? Overuse may diminish the wicking Are barrier creams being used? Overuse may diminish the wicking

action.action. Has the product been “doubled-up” in an effort to maximize Has the product been “doubled-up” in an effort to maximize

absorbency? Products are designed to be used as a single product. Pads absorbency? Products are designed to be used as a single product. Pads inserted into the brief will hinder the absorbency process and may inserted into the brief will hinder the absorbency process and may cause leakage. (Unless a diaper doubler, designed for an extra layer in cause leakage. (Unless a diaper doubler, designed for an extra layer in the brief for more absorbency. These are just made of the fluff, no lining the brief for more absorbency. These are just made of the fluff, no lining at all.at all.

Skin Irritation:Skin Irritation: Is the skin “scalded” at the mid-thigh area? Product may not be close Is the skin “scalded” at the mid-thigh area? Product may not be close

enough to the body. Postion product close to the body for a snug fit.enough to the body. Postion product close to the body for a snug fit. Is the skin blistered at the upper thigh? Elastics may be positioned Is the skin blistered at the upper thigh? Elastics may be positioned

incorrectly. Leg elastics should rest on the natural creases of the groin.incorrectly. Leg elastics should rest on the natural creases of the groin. Other potential causes of skin irritation: Infrequent absorbent product Other potential causes of skin irritation: Infrequent absorbent product

changes, inadequate skin care of pericare, and lack of repositioning.changes, inadequate skin care of pericare, and lack of repositioning.

Troubleshooting Guide Troubleshooting Guide continuedcontinuedAbsorbency:Absorbency:

Is the client in the proper product? Is the client in the proper product? Is the client using the proper sized brief? A product too large will leak because of Is the client using the proper sized brief? A product too large will leak because of

sagging.sagging. Is the product making contact with the perineal area? Fit should be snug.Is the product making contact with the perineal area? Fit should be snug.

Odor:Odor: Is the client receiving thorough pericare after each incontinence episode?Is the client receiving thorough pericare after each incontinence episode? Are soiled products being rolled up and secured before disposal? It is recommended Are soiled products being rolled up and secured before disposal? It is recommended

wrapping used items in plastic shopping bags or plastic gloves before disposing. wrapping used items in plastic shopping bags or plastic gloves before disposing. Also, make sure you are using a trash receptacle with a secure lid.Also, make sure you are using a trash receptacle with a secure lid.

Medicaid is the only insurance Medicaid is the only insurance that will cover incontinence that will cover incontinence products. They pay $130.00 a products. They pay $130.00 a month from date delivered!!!!month from date delivered!!!!

Wipes Wipes ARE NOTARE NOT a covered item!!!! a covered item!!!!

Diabetic Products based on Diabetic Products based on the diagnosisthe diagnosis

INSULIN DEPENDENTINSULIN DEPENDENT 6 boxes of strips 6 boxes of strips

MAXIMUM PER MAXIMUM PER QUARTER (300 STRIPS QUARTER (300 STRIPS TOTAL) and 3 boxes of TOTAL) and 3 boxes of lancets. lancets.

This is for supply up to 3 This is for supply up to 3 times a day testing (TID) times a day testing (TID) ****You only give them ****You only give them the quantity of strips and the quantity of strips and lancets needed per the lancets needed per the prescription on file, not prescription on file, not automatically 300 automatically 300 strips****strips****

NON-INSULIN NON-INSULIN

DEPENDENTDEPENDENT 2 boxes 2 boxes of strips MAXIMUM of strips MAXIMUM PER QUARTER (100 PER QUARTER (100 STRIPS TOTAL) and 1 STRIPS TOTAL) and 1 box of lancets. This is box of lancets. This is for supply up to 1 for supply up to 1 time a day testingtime a day testing

INFORMATION BASED ON MEDICARE GUIDELINES & STANDARDS

Medical Documentation Medical Documentation RequiredRequired

• Medical documentation is required Medical documentation is required every 6 monthsevery 6 months

• Prescription from physician with Prescription from physician with testing frequency and diagnosistesting frequency and diagnosis

• Physician notes documenting the Physician notes documenting the testing frequency, reason for testing testing frequency, reason for testing frequency, frequency,

• follow- up notes pertaining strictly to follow- up notes pertaining strictly to the diagnosis requiring the diabetic the diagnosis requiring the diabetic testing and treatment.testing and treatment.

Types of Glucometers Types of Glucometers Covered and the Covered and the RequirementsRequirementsStandard GlucometerStandard Glucometer: (E0607): (E0607)

Patient must meet all the following criteria:Patient must meet all the following criteria:1.1. Diagnosed with and treated for Diabetes (ICD-9 codes 250.00-250.93)Diagnosed with and treated for Diabetes (ICD-9 codes 250.00-250.93)2.2. Monitor and related supplies must be ordered by the physician treating Monitor and related supplies must be ordered by the physician treating

the diabetesthe diabetes3.3. Patient or caregiver must have completed training on the use of the Patient or caregiver must have completed training on the use of the

equipmentequipment4.4. Patient is capable of using the test results to control their glucose Patient is capable of using the test results to control their glucose

levelslevels5.5. The device is designed for home useThe device is designed for home use

Special Feature MonitorsSpecial Feature Monitors (for the visually (for the visually challenged) E2100: visually impaired challenged) E2100: visually impaired oror E2101: E2101: manual dexterity impaired)manual dexterity impaired)

1.1. All the above basic criteria are met All the above basic criteria are met ANDAND2. The treating physician certifies severe visual impairment (20/200 or

worse in both eyes) (for E2100 or E2101)3. Specific visual acuity is documented (for E2100 or E2101)4. Treating physician certifies the patient’s severe impairment of manual

dexterity (Physician’s narrative statement must be on file) (for E2101 only-is not dependent upon a visual impairment)

Covered Accessories and Covered Accessories and SuppliesSupplies

Covered SuppliesCovered Supplies• Blood glucose test strips Blood glucose test strips

(A4253) 1 unit=50 strips(A4253) 1 unit=50 strips• Lancets (A4259) 1 Lancets (A4259) 1

unit=100 lancetsunit=100 lancets• Glucose control solutions Glucose control solutions

(A4256)(A4256)• Spring powered lancing Spring powered lancing

device (A4258)device (A4258)

Non-Covered SuppliesNon-Covered Supplies• Alcohol or peroxide

(A4244, A4245)• Betadine or phisoHex

(A4245, A4247)• Urine reagent strips or

tablets (A4250)• Home glucose disposable

monitor (A9275)• Continuous glucose

monitor• Reflective colorimeter

devices

Not Medically NecessaryNot Medically Necessary

• Laser skin piercing device (E0620)Laser skin piercing device (E0620)• Replacement lens shield cartridges Replacement lens shield cartridges

(A4257)(A4257)

Normal Utilization Normal Utilization GuidelinesGuidelines

Patients Patients notnot treated with insulin injections:• 100 test strips, 100 lancets every 3 months100 test strips, 100 lancets every 3 months

Patients being treated with insulin:Patients being treated with insulin:• 100 test strips and 100 lancets every 100 test strips and 100 lancets every

month. Medicare, month. Medicare, the only insurance the only insurance that doesthat does; allows supplies shipped for a 3 ; allows supplies shipped for a 3 month period at time. That would be 300 month period at time. That would be 300 test strips and 300 lancets a quarter (every test strips and 300 lancets a quarter (every three months).three months).

Guidelines for Excess Guidelines for Excess UtilizationUtilization

Patients who exceed normal guidelines must meet all the Patients who exceed normal guidelines must meet all the following criteria:following criteria:

1.1. All basic criteria 1 through 5 are met (on the Standard Glucometer page)All basic criteria 1 through 5 are met (on the Standard Glucometer page)2.2. Supplier maintains order in the patient’s recordSupplier maintains order in the patient’s record3.3. Patient’s supply on hand is nearly exhaustedPatient’s supply on hand is nearly exhausted4.4. Treating physician ordered a frequency of testing that exceeds utilization Treating physician ordered a frequency of testing that exceeds utilization

guidelines (documented with specific reason in medical record required)guidelines (documented with specific reason in medical record required)5.5. Treating physician has seen the patient and evaluated their diabetes Treating physician has seen the patient and evaluated their diabetes

control within six (6) months of prior to any order for quantities that control within six (6) months of prior to any order for quantities that exceed the normal utilization guidelinesexceed the normal utilization guidelines

• Must be documented in the physician’s medical recordsMust be documented in the physician’s medical records• Additional physician visits are not requiredAdditional physician visits are not required

6.6. There is documentation that frequency of testing matches physician’s There is documentation that frequency of testing matches physician’s orderorder

• A copy of the patient’s testing log, orA copy of the patient’s testing log, or• A statement in the physician’s medical record indicating the log was reviewed A statement in the physician’s medical record indicating the log was reviewed

and how often testing was doneand how often testing was done• New documentation required every six (6) monthsNew documentation required every six (6) months

Documentation Documentation RequirementsRequirements

A detailed written order is required prior to billing A detailed written order is required prior to billing for the product; which has to includefor the product; which has to include::

• Patient’s namePatient’s name• All items to be dispensed (details)All items to be dispensed (details)• Options or additional features needed by the patientOptions or additional features needed by the patient• Specific frequency of testingSpecific frequency of testing• Treating physician’s signature and dateTreating physician’s signature and date• Start date if different from the signature dateStart date if different from the signature date***Note: If the physician’s order only lists frequency of ***Note: If the physician’s order only lists frequency of

testing as PRN or “as needed”, it is not medically testing as PRN or “as needed”, it is not medically necessary…you must get a set frequency.***necessary…you must get a set frequency.***

A new written order is required whenA new written order is required when::• There is a change in the frequency of testingThere is a change in the frequency of testing• There is a change in supplier for the glucose monitor There is a change in supplier for the glucose monitor

and/or suppliesand/or supplies