VGM HOMELINK - Product Catalog

August 19, 2008

PRODUCT CATALOG

MEDICAL SUPPLIES
Ostomy Supplies		Item#	Manufacturer
	Drainable Pouches
	Wafers/Skin Barriers
	Protective Barrier Wipe
	Stoma Paste
	Other
Wound Care Supplies		Item#	Manufacturer
	Gauze Pads
	Tape
	Gloves
	Saline & Sterile Water Solution
	Roll Gauze
	Specialty Gauze (i.e. xeroform, adaptic, etc.)
	Other
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BONE GROWTH STIMULATORS
	Spinal Bone Growth Stimulator	(Brand)
	Regular Bone Growth Stimulator	(Brand)

TENS-ELECTROMEDICAL
Premium TENS Units
Used for chronic pain control. Stimulates sensory nerves.
	Comfor-tens	PURCHASE ONLY. Standard unit, burst, constant, modulated mode, adjustable rate and width.
	Maxima
	Maxima II
	Spectrum Max SD	info
	Nu Wave
	BioStim LX
	BioStim M7
	Other
Muscle Stimulators
	NM III	Adjustable settings. 16 preset protocols
	EMS+2	Adjustable settings ONLY. No preset protocols.
	Other
Interferential Stimulators
Used for pain control and increases blood flow. Deeper penetration in the tissue.
	IF II	Has muscle stim cycle, digital and can tell doctor how often the patient has used the unit and for how long.
	INF Plus	Comparable to IF II, but does not have muscle stim cycle.
	Other
Galvanic Stimulators
Reduces swelling and controls pain.
	GVII	Reduced swelling, adjustable frequency, high voltage.
	Biomed GV350	Offers continous alternating stimulation (5 seconds on, 5 seconds off)
	Other
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NURSING SERVICES

HOMELINK must have a copy of Doctor's order prior to start of care. Fax orders to 1-800-736-1943.
Home Health Services
	RN/LPN	OT
	PT/PTA	MSW
	ST	HHA
	Other
	Start of Care Section

MEDICAL TRANSPORTATION
Transportation Service Required
Select one of the following:
	Ambulatory Transport
	Wheelchair Transport
	Stretcher Transport
	Basic Life Support (Ambulance)
	Advanced Life Support (Ambulance)
	Other
Please select type of order being submitted:
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CATASTROPHIC CARE COORDINATION

DIABETIC EQUIPMENT AND SUPPLIES
	Insulin Pump	(Brand & Model #)
	Infusion Sets	(Brand, Model, & Length)
	Reservoirs/Cartridges	(Model of Pump)
	Batteries	(Model of Pump)
	Skin/IV Preps	(Brand)
	Dressings	(Brand & Size)

	Glucometer	(Brand)
	Test Strips	(Brand)
	Lancets	(Brand)
	Lancet Device
	Syringes	(Brand)
	Syringes	Length: Gauge: # of cc’s:
	Insulin	Name & Vial or Pen Needle
	Urine Test Strips
	Dressings	(Brand & Size)
	Glucose Tablets	(Flavor)
	Alcohol Wipes
	Control Solution	(Brand of Glucometer)
	Pen Needles	(Brand & Size)
	Glucagon Emergency Kit
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MEDICATIONS

ORTHOTICS AND PROSTHETICS
Product Prescribed:
Please describe, in detail, the product prescribed by Doctor or Therapist.

Comments:

L Codes:
Please list all L Codes for product being ordered for an accurate quote of pricing according to the state fee schedule per injury state.

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RESPIRATION THERAPY
CPAP/BI-Level
Prescription Required.
Rental Purchase
Diagnosis:
Initial set-up will have extra charges of headgear and mask, which are purchases and can not be rented.
Other:
Nebulizers
Purchase Only
Standard (bedside) Ultrasonic (portable) Both
Frequency Treatments:
Are we doing the medications: Yes No
Diagnosis:
Other:
O2 Concentrator
Prescripton Required
LPM:	Liters per Minute (LPM) higher than 6 require a liquid system.
	Nasal Cannula Venti Mask
VIA:	Simple Mask Trach Collar
	Other
Diagnosis:
Humidification:	Yes No
	Rental Purchase
Other:
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IV THERAPY

HOMELINK must have a copy of Doctor's order prior to start of care. Fax orders to 1-800-736-1943.

Type of Line:

Central Line

PICC

Peripheral Line

Other

Time therapy needs to start:

Drug name and amount:

Multiple Drug name and amount:

Chemo

Drug name and amount:

Frequency:

Cont Chemo

Intermittent Chemo

Pain Management

Drug name and amount:

Frequency:

Pain Mgmt

Cont Pain Mgmt

Injection

Drug name and amount:

Frequency:

Sub Q

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WOUND CARE
	Negative pressure wound therapy pump
Support Surfaces
	-mattress overlay
-
	-alternating pressure pad (overlay)
	-low air loss overlay
	-alternating pressure mattress
	-low air loss mattress
-
	-air-fluidized bed
-
	-Other specialty support surfaces