---
title: VNS Therapy Patient Form
---

" />

# VNS Therapy™ Patient Authorization Form

This document is no longer necessary. If you would like to speak to a LivaNova representative, please complete this [form](https://www.livanova.com/epilepsy-vnstherapy/en-us/contact-us)<https://www.livanova.com/epilepsy-vnstherapy/en-us/contact-us>or contact your physician if you have questions.

```json
{
  "@context" : "http://schema.org",
  "@type" : "MedicalCondition",
  "SameAs" : [ "hard-to-treat epilepsy", "drug-resistant epilepsy", "drug-resistant seizures" ],
  "alternateName" : "epileptic seizures",
  "associatedAnatomy" : {
    "@type" : "AnatomicalSystem",
    "name" : "neurological"
  },
  "code" : {
    "@type" : "MedicalCode",
    "code" : "G40",
    "codingSystem" : "ICD-10"
  },
  "name" : "epilepsy",
  "signOrSymptom" : [ {
    "@type" : "MedicalSymptom",
    "name" : "seizures"
  }, {
    "@type" : "MedicalSymptom",
    "name" : "fits"
  } ]
}
```

```json
{
  "@context" : "http://schema.org",
  "@type" : "MedicalTherapy",
  "alternateName" : "Vagus Nerve Stimulation",
  "code" : {
    "@type" : "MedicalCode",
    "code" : "G40",
    "codingSystem" : "ICD-10"
  },
  "description" : "VNS Therapy is designed for people living with uncontrolled, hard to treat or drug resistant seizures, including epilepsy.",
  "name" : "VNS Therapy"
}
```