Doctor Discussion Guide

Thank you for your interest in Cala Trio™. Below is your guide to discussing Cala Trio with your doctor. Please take the Prescription form to your next doctor appointment. Your doctor may not know about Cala Trio therapy and clinical results. If you communicate with your doctor using an online health portal, consider sending them this link: https://calatrio.com/healthcare-professionals/ in a secure message so they can learn more about the Cala Trio therapy.

You can also download a printable version of the guide. To ensure measuring accuracy please print on 8.5″ x 11″ paper and confirm printer calibrations are properly aligned.

 

 

Talk to your Doctor about Cala TrioTM

Cala Trio medical device shown at angle

The Cala Trio therapy is prescribed by a physician. It is indicated to aid in the transient relief of hand tremors in the treated hand following stimulation in adults with essential tremor.

Essential tremor (ET) is a common movement disorder affecting over 7 million Americans.1 The condition is marked by primarily hand tremors that make it difficult, if not impossible, to perform daily activities like eating, drinking, and writing.

Symptoms2 of essential tremor include:

  • Uncontrollable shaking that occurs when you use your hands
  • Shaking voice
  • Nodding head
  • Tremors that get worse with emotional stress
  • Tremors that get worse with intentional movement
  • Tremors that lessen with rest

If essential tremor makes it difficult to perform daily activities, there are treatment options including:

  • Medications
  • Physical or Occupational therapy
  • Brain surgery

Now a breakthrough in essential tremor is here.

Cala Trio has a wrist band that delivers electrical stimulation to the nerves in the wrist. The stimulation disrupts the tremor network in the brain and delivers meaningful tremor reduction in the treated hand. An effective, safe tremor therapy is here.

Your life and your experience with essential tremor are unique. Finally, an individualized treatment is here.

Visit your doctor to discuss adding Cala Trio to your tremor therapy by sharing the following information:

1. How long have you experienced tremors?

☐ <5 years
☐ 5-15 years
☐ >15 years

2. Does your tremor lead to embarrassment or anxiety when you are around others?

☐ Yes
☐ No

3. Does your tremor impact your ability to work?

☐ Yes
☐ No

4. How does your tremor interfere with your life? Which daily activities are difficult for you to perform due to your tremor?

☐ Writing
☐ Drinking beverage
☐ Texting/typing
☐ Hand crafts
☐ Putting on make-up
☐ Other hobbies

5. Have you tried taking any medications for your essential tremor?

☐ Yes
☐ No

If yes
a. Which medications?

☐ Topiramate
☐ Gabapentin
☐ Propranolol
☐ Primidone
☐ Other __________________________

b. Have these medications been effective?

☐ Yes
☐ No

c. Have they caused side effects?

☐ Yes
☐ No

d. Do these medications interact with your other medications?

☐ Yes
☐ No

If you have any additional questions about Cala Trio
please contact us at 888-699-1009 or
CustomerSuccess@CalaTrio.com

1 Louis, Elan D, and Ruth Ottman. “How many people in the USA have essential tremor? Deriving a population estimate based on epidemiological data.” Tremor and other hyperkinetic movements (New York, N.Y.) vol. 4 259. 14 Aug. 2014, doi:10.7916/D8TT4P4B

2 Nazario, B. (2007). The Brain and Essential Tremor. Retrieved from https://www.webmd.com/brain/essential-tremor-basics#1

Cala Trio Customer Success

Prescription and Order Form

Fax completed form to: 1-833-230-9251
Health Care Professional Line: 1-888-585-7101
Cala Trio Customer Success: 1-888-699-1009

Prescriber Information

First Name*

Last Name* (MD/DO/CRNP/PA)

NPI#*

Practice Name/Institution*

Office Contact Person*

Office Contact Phone*

Address

City

State

ZIP

Phone

Fax

Email*

Patient Information

First Name*

Last Name*

DOB*

Home Address

City

State

ZIP

Primary Phone*

Email*

Gender M/F*

Payer Name*+

Payer Phone*+

Payer ID*+

* Required Fields
+ Not required for VA Patients

Cala Trio Customer Success will contact your patient to discuss payment options and provide product support.

Medical Necessity

For each task listed, circle the number that best describes how your patient is able to perform the activity.

Able to do activity without difficulty Able to do activity with little effort Able to do activity with a lot of effort Cannot do without assistance
Use a spoon to drink soup 1 2 3 4
Hold a cup of tea or coffee 1 2 3 4
Write a letter 1 2 3 4

Has the patient previously tried medication for essential tremor?

  • Yes
  • No

Prescribing Information

Diagnosis: ICD-10 Code:

  • G25.000 Essential Tremor
  • Other
  • Rx - Cala Trio Therapy, 12 months
    1 Cala Trio Stimulator, 4 Cala Trio Bands

To expedite fulfillment, please complete the following parameters
Cala Trio is designed to stimulate nerves in the left OR right wrist. The device is NOT interchangable between the left and right hand.

  • Right Hand Device
  • Left Hand Device

Measure the patient’s wrist circumference over the head of the ulna to determine band size:

  • Small — 13.6 - 16.4cm
  • Medium — 16.5 - 18.4cm
  • Large — 18.5 - 20.4cm

The ”Tremor Task” is a postural hold that helps characterize the patient’s tremor. CHOOSE the MORE SEVERE postural hold to perform around therapy.

  • Outstretched
  • Wing Beating

Indication for Use:

To aid in the transient relief of hand tremors in the treated hand following stimulation in adults with essential tremor (ET).

Caution: Federal law restricts this device to sale by or on the order of a physician.

Contraindications:

Cala Trio Therapy System should NOT be used:

  • by patients with an implanted electrical medical device, such as a pacemaker, defibrillator, or deep brain stimulator.
  • by patients that have suspected or diagnosed epilepsy or other seizure disorder.
  • by patients who are pregnant.
  • on swollen, infected, inflamed areas, or skin eruptions, open wounds, or cancerous lesions.

Provider Authorization

I hereby attest that this order accurately reflects signatures/notations that I made in my capacity as the above-mentioned patient's provider. I do hereby attest that this information is true, accurate and complete to the best of my knowledge and I understand that any falsification, omission, or concealment of material fact may subject me to administrative, civil, or criminal liability.

Prescriber's Signature X

Date: