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REQUEST FOR IMPLANTABLE CARDIOVERTER DEFIBRILLATOR (ICD)Date: Send ALL relevant documentation with this request (e.g. consult notes, lab results, ECG, Holder monitor, and/or echo) SPH BOOKING OFFICE:

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How to fill out request for implantable cardioverter

01

Make sure you have all the necessary medical information and documentation from your healthcare provider.

02

Contact your insurance company to determine if the procedure is covered and what the requirements are for approval.

03

Fill out the request form completely and accurately, providing all relevant personal and medical information.

04

Submit the request form to your healthcare provider for review and approval.

05

Follow up with your healthcare provider and insurance company to ensure that the request is processed in a timely manner.

Who needs request for implantable cardioverter?

01

Patients who have been diagnosed with certain heart conditions, such as ventricular tachycardia or ventricular fibrillation, may need an implantable cardioverter to help regulate their heart rhythm.

02

Individuals who have a history of sudden cardiac arrest or who are at high risk for developing life-threatening arrhythmias may also benefit from an implantable cardioverter.

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What is request for implantable cardioverter?

Request for implantable cardioverter is a formal application to obtain approval for the placement of a device that helps manage abnormal heart rhythms.

Who is required to file request for implantable cardioverter?

Patients who require implantable cardioverter are required to file the request, along with their healthcare provider.

How to fill out request for implantable cardioverter?

To fill out the request for implantable cardioverter, patients need to provide their personal information, medical history, and details about their condition.

What is the purpose of request for implantable cardioverter?

The purpose of the request for implantable cardioverter is to seek approval for the placement of the device to help manage abnormal heart rhythms and improve the patient's quality of life.

What information must be reported on request for implantable cardioverter?

The request for implantable cardioverter must include the patient's personal information, medical history, details about their condition, and the recommendation from their healthcare provider.

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