The Rocket Medical Prescription form, or Certificate of Medical Necessity (CMN) is a critical component in our efforts to support a patient’s continuity of care. Ensuring that the CMN is filled in completely and accurately will assist in arranging for the timely availability of drainage supplies.

The CMN is available here on this site as a PDF.
Hard copies may also be found with each insertion kit, or from your local representative.

Please send completed form and last two chart notes via online submission, or via email / fax at:


Fax: 781.735.5515