Submit Your Prescription

Use this secure form to submit an oxygen prescription for an Americare order. It is available to every customer, including anyone who has already placed an order and still needs to send a prescription.

Already placed your order?

Enter your Shopify order number and the email address used at checkout in the secure form. If you have not placed an order yet, the order number is optional.

You may place an order for an oxygen concentrator before your prescription is ready. Americare will keep the concentrator order under review and will not release it for fulfillment until the prescription has been received and reviewed.

Open the secure prescription form

The form is hosted securely by Hushmail, and Hushmail indicates that submitted information is encrypted. Please do not send prescription documents through regular email or the general contact form.

Check the prescription before you upload it

To help us review it without needing to request corrections, make sure the complete, readable prescription shows:

  • The patient’s full name
  • The prescriber’s name and signature
  • Whether oxygen is prescribed as continuous flow, pulse dose, or both
  • The prescribed continuous-flow rate in liters per minute (LPM) and/or pulse-dose setting, as applicable
  • When oxygen is needed, including any different instructions for rest, activity, or sleep

A pulse-dose setting is not the same as a continuous-flow rate in LPM. Upload every page of the prescription. If a required detail is missing or unclear, we may need to contact you or the prescriber before releasing the order.

The secure form asks for the patient’s name, the submitting person’s name and relationship to the patient, and the email address associated with the order so we can match the document correctly.

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