Create New Order
Capture patient information, insurance details, product selections, and pricing in a structured workflow.
Order Workflow
1 step requires attentionPatient Information
Complete
Insurance Verification
Verified
Product Selection
2 products added
Documentation
Measurements missing
Approval
Awaiting submission
Patient Information
Primary patient details and shipping destination.
Insurance Information
Coverage details required for billing and prior authorization checks.
Product Selection
Add products for this order. Pricing is sourced from the active vendor catalog.
| Product | Vendor | Qty | Unit Cost | Billable | |
|---|---|---|---|---|---|
Compression Sleeve – Grade 2 | Juzo USA | $89.50 | $450.00 | ||
Lymphedema Kit – Full Arm | Solaris Medical | $145.00 | $380.00 |
Recommended Vendor
Business rulesSolaris Medical
Best overall margin for this order
Fastest average fulfillment time
Estimated delivery: 2–3 business days
Measurements & Requirements
Clinical documentation required before this order can be processed.
Prescription Received
Signed physician prescription has been received and filed.
Therapist Measurements Uploaded
Certified therapist measurements required for custom compression products.
Upload measurement file
PDF, JPG, or PNG accepted
Missing measurements will block order processing.
Prior Authorization Required
Mark if this order requires prior authorization from the insurance provider before fulfillment.
Internal Notes
Operational comments visible only to the fulfillment team.
Not visible to patients or insurance providers.
Order Summary
Updates as you fill the form
Patient
Maria Rodriguez
Selected Products
Compression Sleeve – Grade 2
Juzo USA
Lymphedema Kit – Full Arm
Solaris Medical
Pricing Summary
Next Steps
Submit for Approval
Generate Documents
Send Invoice
Vendor Fulfillment
Proof of Delivery Signature
Operational Checks
1 warningAutomated workflow validation
Pricing calculated
Vendor selected
Therapist measurements missing
Margin above target threshold
Checks update as you complete the form. Warnings do not block submission.