How to Order LifeVest

To order a LifeVest® wearable cardioverter defibrillator (WCD), you have the choice of using the Medical Order form, placing a chart order, or placing a verbal order. In each case, documentation must be provided to support the diagnosis and medical necessity of the LifeVest WCD. Specific instructions are provided below.

To place a Medical Order

Complete the Medical Order and fax it to ZOLL. Click on the link below to download the form and instructions.

 Medical Order Form and Instructions (US English)

 ICD-10 Codes for Selected Cardiac Diagnoses

 Fax Cover Page

 

To place a chart order

Specific information must be provided. Click on the link below for instructions.

 Chart Order Instructions Pocket Card

 

To place a verbal order

Specific information must be provided. Click on the link below for instructions.

 Verbal Order Instructions