Please enter first name
Please enter last name
Please provide an email
Phone must be 10 digits
Zip must be 5 digits

Patient Forms

After completing the form(s), you may fax, mail, or email the form(s) to us. If you choose to email the form(s), please note that Advanced Cardio Services® cannot assure the security of your email transmission so there is a risk that your protected health information (PHI) could be read, viewed or otherwise accessed by a third party. If you continue to send this email, you will have assumed this risk to email the form(s) to us. There is no requirement to send the form(s) via email.

  • Email: ContactACS@Lincare.com
  • Fax: 844.700.3484
  • Mailing Address: 2001 N.E. 46th Street, Suite 152, Kansas City, MO 64116

 

ACS® Patient Enrollment Form

When you identify a new PT/INR Self-Testing patient, complete the Patient Enrollment Form. View, print, or save the Patient Enrollment Form.

DOWNLOAD


ACS® Patient Management Info

Clinical benefits and proven effects of weekly self-testing.

DOWNLOAD


Time in Therapeutic Range

ACS® patients are within prescribed therapeutic range 86% of the time.

DOWNLOAD


Checking Your PT/INR

As a warfarin patient, you now have the option of checking your PT/INR at home, anytime.

DOWNLOAD


PT/INR Self-Testing

Is it right for you? Take charge of your INR testing today!

DOWNLOAD


Sample Patient Result

A sample of the report you will receive of patient INR results.

DOWNLOAD


CPT Code

Code for Anticoagulation Monitoring, in office vs. home testing services.

DOWNLOAD


CoagTrak®

Warfarin patient management solution for point-of-care, lab drawn, home drawn and self-testing patients.

DOWNLOAD


Digital Ordering/E-Prescribing

Prefer to order everything electronically. Place your next INR order via Parachute today!

DOWNLOAD


mdINR® App Instructions

Quick start user guide for patient reporting of weekly INR results via our mdINR® app.

DOWNLOAD


roche coaguchek xs

Choose ACS® Today

ACS is committed to assisting individuals on long-term warfarin therapy with a comprehensive anticoagulation program that allows patients to self-test for INR from the comfort of home. ACS provides industry-leading products, dependable services, and ongoing support that helps patients every step of the way.

If you are interested in learning more about how you can self-test for INR from the comfort and safety of home, contact us today.

X
Cookies help us improve your website experience.
By using our website, you agree to our use of cookies.
Confirm