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To order a LifeVest system, 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. Specific instructions are provided below.
For assistance with the ordering process, call 1-800-543-3267.
To place a Medical Order
Complete the Medical Order and fax it to ZOLL Lifecor. Click on the link below to download the form and instructions.
 Medical Order Form and instructions
ICD-9 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
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