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e) Reason for LifeVest (Check One): ? Cardiac arrest due to VF or sustained VT. ? Familial or inherited condition with SCA risk. ? MI with an EF of ?35%. (LifeVest, ZOLL, Pittsburgh, Pennsylvania) is a device which. can be used to bridge the situation when a patient is waiting. for an ICD. Medical Order Form. ZOLL. LifeVest. PLEASE COMPLETE ALL FIELDS. 1) Patient Information and Condition a) Patient Name (Print First and Last Name).The ZOLL LifeVest Wearable Cardioverter Defibrillator, or LifeVest device, is a microprocessor based and programmable patient-worn defibrillator that. f) Signature Date (DD/MM/YYYY). _____ / _____ / ______. Phone 001 800 4008 0070. Fax 6807 1699. PDF LifeVest.Orders-SG@zoll.com. Ejection Fraction (EF). ZOLL LIFEVEST. Wearable Cardioverter Defibrillator LifeVest is 97% sensitive to VT and 100% sensitive to VF. • LifeVest is 100% specific to VT and VT ZOLL LifeVest. A Proven Therapy for Patients at Risk of Sudden Cardiac Death. What is the LifeVest. Wearable Defibrillator? Title: ZOLL LifeVest Medical Order Form ENG_US Subject: Complete this Medical Order form for the LifeVest and submit to ZOLL by fax or email. To order a LifeVest® wearable cardioverter defibrillator (WCD), you have the choice of using the Medical Order form, placing a chart order, registry of patients using the wearable cardioverter defibrillator (WEARIT-II Registry). Circulation 2015;132(17):1613-1619. © 2020 ZOLL Medical Corporation.

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