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PRESCRIPTION FOR PELVIC FLOOR ELECTRICAL STIMULATOR (E0740) Patients Name ___ Patients Address ___ StreetCityStateZipPatients Phone___D. O.B.___ The patient has undergone and failed a documented trial
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How to fill out pelvic floor electrical stimulation

01
Ensure the device is properly charged or has fresh batteries.
02
Clean the area where the electrodes will be placed with mild soap and water.
03
Apply a conducting gel to the electrodes to ensure proper conduction of the electrical impulses.
04
Place the electrodes on the pelvic floor muscles as directed by the manufacturer.
05
Turn on the device and adjust the intensity to a comfortable level.
06
Follow the recommended treatment plan provided by your healthcare provider.
07
Keep track of any changes or improvements in your symptoms.

Who needs pelvic floor electrical stimulation?

01
Pelvic floor electrical stimulation may be recommended for individuals with conditions such as urinary incontinence, fecal incontinence, pelvic pain, or pelvic floor muscle weakness.
02
It may also be used as part of a rehabilitation program after certain surgeries or medical procedures.
03
It is important to consult with a healthcare provider to determine if pelvic floor electrical stimulation is appropriate for your specific condition.
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Pelvic floor electrical stimulation is a therapeutic technique that uses controlled electrical impulses to stimulate the pelvic floor muscles, helping to strengthen and improve their function.
Typically, healthcare providers who administer pelvic floor electrical stimulation treatments to patients may be required to file related documentation or claims for reimbursement.
Filling out pelvic floor electrical stimulation documentation usually involves providing patient information, the nature of the treatment, duration, and outcomes. Specific forms may vary depending on the provider or insurance requirements.
The purpose of pelvic floor electrical stimulation is to improve muscle strength, reduce pelvic pain, enhance bladder control, and treat conditions such as urinary incontinence or pelvic floor dysfunction.
Information that must be reported typically includes patient demographics, treatment dates, specific stimulation parameters used, treatment goals, and any outcomes or progress observed.
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