BCV Clinical Order Form

This will email the draft order to the physician with a link to review and sign. Once you send it, the order moves to "Awaiting signature" status. You can still view (and edit if needed) before they open it.

The physician will receive an email with the secure link. They'll need the patient's last name and date of birth to access the form. Their session lasts 3 days. Auto-reminders are sent at 48 hours and 5 days if they haven't signed.

BCV is non-invasive negative-pressure ventilation delivered through a lightweight chest cuirass. Unlike mask-based positive-pressure ventilation, BCV supports both inhalation and active exhalation, providing ventilatory support and secretion clearance in a single therapy.

Clinical applications

BCV is particularly valuable for patients who cannot tolerate or are not appropriate for mask-based positive-pressure ventilation. Indications include:

• Neuromuscular disease (ALS, muscular dystrophy, SMA, etc.)
• Chronic respiratory failure
• Bulbar weakness
• Restrictive chest-wall disorders
• Complex airway clearance needs
• Post-extubation support

Approved for infants through adults, in the home or clinical setting.

The Hayek is a prescription-only medical device. All treatment decisions remain with the ordering physician.

What this form produces

This short clinical intake guides you through an 8-step assessment and generates a complete physician order packet, including:

• Patient-specific clinical justification (Letter of Medical Necessity)
• Recommended equipment settings (the prescription)
• Physician signature and clinical attestation
• Insurance submission package — ready for prior authorization

Process and timeline

The form takes approximately 5–10 minutes to complete. Your work is automatically saved as you go, so you can step away and return any time.

1. Complete the 8-step clinical intake — patient information, diagnosis, current therapy, clinical findings, and recommended BCV settings.
2. Review the generated order packet — edit any field, add additional clinical context if needed.
3. Sign electronically and submit — one signature event with enumerated clinical attestations.
4. Hayek handles the rest — our preferred homecare partner manages fulfillment, prior authorization, appeals, patient onboarding, and ongoing clinical support.

Privacy & security

This form contains protected health information (PHI). Accessing a draft requires the patient's last name and date of birth. After 3 incorrect attempts, the draft is temporarily locked for 15 minutes. All access is logged with timestamp, role, name, and attestation for compliance audit.

Your verified session lasts 3 days, then expires automatically. You can end your session manually at any time using the "End session" button in the header (useful on shared clinical computers).

Questions or prefer a different process?

Call our clinical team at 1-855-243-8228 — Monday–Friday, 9am–5pm Eastern. We can answer clinical questions, help complete the form by phone, arrange a peer-to-peer review, or accept your order by fax with your own Letter of Medical Necessity — whichever workflow is most convenient.

The Hayek is a prescription-only medical device. This form generates documentation to support clinical ordering and insurance submission. All treatment decisions remain with the ordering physician.