
The patient herein referred is homebound per CMS Guidelines as determined by the Ordering Physician. When ordering tests for patients under Medicare, Physicians or authorized individual should only order test(s) that are medically necessary for the dx(s) and treatment of the patient. IMPORTANT! This facsimile transmission contains confidential some or all of which may be protected health information as defined by the Federal Health Insurance Portability & Accountability Act (HIPAA) Privacy Rule. This transmission is intended for the exclusive use of the individual or entity to whom it is addressed and may contain information that is proprietary, privileged, confidential and/or exempt from disclosure under applicable law. If you are not the intended recipient (or an employee or agent responsible for delivering this facsimile transmission to the intended recipient), you are hereby notified that any disclosure, dissemination, distribution or copying of this information is strictly prohibited and may subject to legal restriction or sanction. Please notify the sender by telephone (numbers listed above) to arrange the return or destruction Of the information and all copies,