Get Certified1 Getting Started2 Watch the Training Video3 Fill Out Certification Form4 Get Added to the RegistryName* First Last Email* WHY GET CERTIFIED?The National Center for Health Statistics reports that nearly 23 million people (12.8 percent of US adults) have symptoms from internal hemorrhoids. Now, the Nexus® Ligator System with EasyFire® technology allows physicians to serve this largely untreated population.Become one of the growing number of physicians who have completed certification training to use the Nexus Ligator System for patients in recurrent or chronic internal hemorrhoidal symptoms in Grade I through III hemorrhoids. WHY GET CERTIFIED?The National Center for Health Statistics reports that nearly 23 million people (12.8 percent of US adults) have symptoms from internal hemorrhoids. Now, the Nexus® Ligator System with EasyFire® technology allows physicians to serve this largely untreated population.Become one of the growing number of physicians who have completed certification training to use the Nexus Ligator System for patients in recurrent or chronic internal hemorrhoidal symptoms in Grade I through III hemorrhoids.* I certify that I have watched the above videoThe National Center for Health Statistics reports that nearly 23 million people (12.8 percent of US adults) have symptoms from internal hemorrhoids. Now, the Nexus® Ligator System with EasyFire® technology allows physicians to serve this largely untreated population.Become one of the growing number of physicians who have completed certification training to use the Nexus Ligator System for patients in recurrent or chronic internal hemorrhoidal symptoms in Grade I through III hemorrhoids.To be trained on the Nexus Ligator System, you must:Be a licensed medical professional experienced in performing anorectal proceduresBe trained and certified in the correct and comprehensive protocolAgree to comply with the recommended procedure techniqueTo receive Nexus certification, you must:Watch a short 9-minute videoReview important safety informationComplete the Certification FormTo receive your Nexus Ligators, you must: Fill out and return the New Account Form and Order FormContact an inx Medical representative for additional practice support materials After you complete your certification, you will receive an email acknowledging receipt from inx Medical along with a confirmation number required for your initial order. Practice Name*Address* Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*Practice Website Specialty*MD License #** I certify that the information provided on this application is true and accurate. Yes! I am also interested in receiving additional communications about the Nexus Litigator System Download Warranty PDFAll users of any inx Medical Account and Personal Guarantors of all inx Medical Accounts (hereinafter individually and collectively referred to as “you”, “your”, “we”, and/or “our”) agree to the following terms and conditions: Agreement to Terms: You agree to be bound by all terms of the INX Medical Account Holder Agreement and Disclosure Statement (hereinafter referred to as the “Agreement”) and all amendments to this Agreement. Promise to Pay: You promise to pay all amounts incurred by (1) you, or from which you receive a benefit; or (2) others with actual, authorized, implied, or apparent authority to use your inx Medical Account (hereinafter referred to as “Account”). You agree to pay for charges incurred by others to whom you voluntarily provided your Account number. Special Responsibilities for Accounts: You agree to accept liability for any and all purchases made by your employees, whether or not the employee uses the Account in a manner authorized by you. Transfer of an Account from the doctor/facility named on the Account to another doctor/facility is prohibited; the Account must be closed and a new account must be opened for the new doctor/facility. Payments: Payments must be made within thirty (30) days of invoice date. Forms of payments accepted are check, money order, Visa, MasterCard, or American Express. Collection Costs and Attorney Fees: You agree to pay all collection costs, including reasonable attorneys’ fees (including in-house counsel), incurred in collecting any amounts owed by you or in enforcing the provisions of this Agreement, whether or not suit is filed. Security Interest: In order to secure your obligations under your Account(s), your Account(s) may be secured by a lien on property and possessions. Default: If (a) you do not pay any invoice when it is due; or (b) you do not comply with any of the terms on the Account or this Agreement or any amendments to it; or (c) you do not pay any other debt when it is due; or (d) you change your primary place of business or (e) you die, become bankrupt or insolvent, or the entity holding your Account is dissolved or merged; or (f) you make any false, misleading or incomplete statements on your application, or (g) you fail to exercise due care in safekeeping your Account(s) or Account information which causes unauthorized use; inx Medical may, without waiving any available legal remedy, without notice or liability to you, do any or all of the following: (1) require you to pay the entire outstanding balance of your account immediately, (2) require additional purchases to be delivered COD (Cash On Delivery) plus the amount of the outstanding balance, (3) place your account on COD for a specified amount of time to be determined at our discretion, and or (4) suspend or terminate your account. Change of Name and Address: You agree to notify us in writing if you change your name or address. The notice must be sent to the address on your statement, Attn: Customer Care. Shipping Terms: FOB Destination Sales Tax Terms: All tax exemption certificates must be submitted to inx Medical prior to issuance of any invoice. If you do not submit the appropriate documentation prior to issuance of any invoice, inx Medical will charge the applicable sales tax. You are responsible for applicable sales tax, whether or not it is charged on the invoice. Billing Disputes: If you think your invoice(s), credit memo(s) or statement is incorrect, or if you need more information regarding an invoice or statement, contact inx Medical Customer Care at 1-888-469-8558. For disputes or questions regarding an invoice, you must contact Customer Care or an inx Medical Representative within thirty (30) days of the date of the invoice. After thirty (30) days, it is your responsibility to pay the invoice(s) in question. Return Policy: No credit can be issued for non-stock products or products that have been opened or damaged, including damage to the packaging of the product. You must request authorization before you return any items. To receive a return authorization number, contact Customer Service. Requests to return products must include the reason for return, the reference part number, the quantity, the lot number, and the invoice number. To receive any credit for returned products, all returned products must be received by inx Medical in their original, unopened packages and be undamaged and packed appropriately for shipping. To receive any credit for returned products, items must be in saleable condition and suitable for restocking. Returned items meeting all of the foregoing conditions (hereinafter referred to as the “Returned Item” or “Returned Items”) will result in credit being applied to your Account as follows: (1) full credit will issue for Returned Items returned within thirty (30) days from the date of the invoice for the Returned Item; (2) Eighty-five percent (85%) credit will issue for Returned Items returned between thirty-one (31) and ninety (90) days from the date of the invoice for the Returned Item; (3) no credit will issue for any product returned after ninety (90) days from the date of the invoice for the product. Returned Items may be subject to a reprocessing charge. Freight charges and shipping & handling fees are non-refundable. Full credit will issue for any product that requires return due to a processing error by inx Medical. ALL CREDITS WILL BE ISSUED IN THE FORM OF CREDIT TO YOUR ACCOUNT. Credit Balance Cash Refund: All requests for refunds on credit balances must be made in writing to inx Medical, Attn: Customer Care, 1819 Clarkson Rd., Suite #206, Chesterfield, MO 63017. For specific criteria concerning cash refund eligibility, see our Cash Refund Policy under Returned Goods Policy located on the back of each statement, invoice, and credit memo. Warranty Policy: For product quality issues, please contact inx Medical Customer Service. In order to qualify under inx Medical’s warranty policy, the product must be returned for evaluation within fifteen (15) days of RGA issuance. Standard product delivery includes a shelf life of one (1) year. Choice of Law: This Agreement shall be construed in accordance with the laws of the State of Missouri, as if this Agreement were made in and to be performed entirely in the State of Missouri. Any disputes under this Agreement shall be brought exclusively in the Circuit Court of St. Louis County, Missouri, and you hereby consent to the personal jurisdiction and exclusive venue of this court, and to service of process by mail, and waive any objection to such jurisdiction, venue and service of process. *PERSONAL GUARANTOR – CORPORATE, LLC, LC or PLC ACCOUNT: The Personal Guarantor of the Account absolutely and irrevocably guarantees and promises to pay to inx Medical, in lawful money of the United States all amounts due on the Account when they become due (by demand, acceleration, or otherwise), all present and future indebtedness due to inx Medical on the Account, whether due or not due, absolute or contingent, liquidated or unliquidated, secured or unsecured, whether customer may be liable individually or jointly with others. Personal guarantor agrees not to assert any statute of limitations or unenforceability defenses with respect to any claims of inx Medical against Personal Guarantor pursuant to this Agreement. Without limiting the foregoing, indebtedness includes, without limitation, interest, attorneys’ fees and other charges on any debt or obligation of any Account holder accruing after the filing of a petition under any chapter of the Federal Bankruptcy Code by or against customer, and any loans or other credit extended to any Account holder after the filing of any such petition, notwithstanding the release of customer from the performance or observance of any of its agreements, covenants or obligations by operation of law. DISCLAIMER OF WARRANTIES: UNLESS OTHERWISE EXPRESSLY PROVIDED HEREIN, INX MEDICAL WARRANTS TITLE TO THE GOODS AND THAT ALL GOODS SOLD HEREUNDER SHALL CONFORM TO SELLER’S STANDARD SPECIFICATIONS. SUBJECT TO THE PRECEDING SENTENCE, INX MEDICAL MAKES NO WARRANTY, EXPRESS OR IMPLIED, AS TO MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, OR ANY OTHER MATTER. INX MEDICAL EXPRESSLY DISCLAIMS ALL OTHER WARRANTIES, EXPRESS OR IMPLIED, INCLUDING, BUT NOT LIMITED TO, ANY IMPLIED WARRANTIES OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE.Review Important Safety Information You must read the important safety information in its entirety. When you have finished reading, scroll down to check the certification box and click continue to step 3.INDICATIONS FOR USE:The inx Medical Nexus® Hemorrhoid Ligator includes suction and ligation capabilities. The ligator is used to disrupt blood flow to hemorrhoidal tissue by means of a ligature placed around the hemorrhoid base. It is for use only by trained medical personnel in hospitals, clinics, and doctors’ offices.NOTES:Do not use this device for any other purpose other than the intended use. The Nexus® Hemorrhoid Ligator is intended to be used only by medical personnel trained in proctology procedures. Store in a clean, dry location, at room temperature.CAUTION:US Federal law restricts this device to sale by or on the order of a physician.CONTRAINDICATIONS:Do not use to treat:Anal polypsExternal hemorrhoidsGrade IV hemorrhoidsPatients with perineal infectionPatients with perineal Crohn’s DiseasePatients with portal hypertensionPatients who are pregnantUse with caution when treating patients on anticoagulants or with bleeding disorders PRECAUTIONS:The Nexus Hemorrhoid Ligator is a disposable device for the rubber band ligation of hemorrhoids. It is for single use only and is supplied with 4 preloaded non-latex rubber bands. Typically a maximum of 3 bands are used during one procedure. An additional band is included as spare.INSTRUCTIONS FOR USE / PROCEDURE:Remove the Nexus Hemorrhoid Ligator from its packaging.Perform a digital rectal exam (DRE) then an anoscopy.Introduce the anoscope into the rectum, targeting the neck of the hemorrhoid to be banded.Introduce the Nexus Hemorrhoid Ligator through the anoscope, and place the tip of the ligator on the hemorrhoid to be banded.Squeeze and hold the suction trigger.Ask the patient if they are experiencing rectal pain. If they are having pain, release the suction trigger; advance the ligator 2-3 mm further into the rectum and repeat steps 4 and 5.Hold suction by continuing to squeeze the suction trigger.While squeezing the suction trigger, pull and release the band trigger to apply a band.Release the suction trigger.When both triggers are released, the Nexus™ Hemorrhoid Ligator will automatically reload the next band.Remove the Nexus Hemorrhoid Ligator and the anoscope from the patient.Repeat a DRE and determine if the following criteria have been met:A sufficient amount of tissue has been banded. The banded tissue should feel like the size of a pea.The banded tissue moves freely when gently probed.The neck of the banded tissue should be small and not broad based.There is no pain on palpation of the banded tissue.If the above four criteria are not met, then digitally manipulate the band to attempt to either slightly decrease the amount of tissue that has been banded or remove the band completely.As per the discretion of the physician, one or two additional bands may be applied to other areas of the rectum by repeating steps 3 through 13.After the procedure is completed, dispose of the Nexus™ Hemorrhoid Ligator in an approved manner. POSITIONING OF THE BAND:The band is applied to the proximal end of the hemorrhoid. The resulting ulceration stimulates a fibrous reaction which gradually adheres the mucosa to the deeper tissues of the rectum and decreases blood flow to the hemorrhoid vessels. Hence, the banding process treats the hemorrhoids by both diminishing blood flow and fixing the mucosa to deeper structures which decreases prolapse. The band must be applied to the most proximal portion of the hemorrhoid since this area is typically not innervated with pain receptors.Question: How does it work? Rubber band ligation works by inducing necrosis and a fibrous reaction at the neck of the hemorrhoid resulting in occlusion of the hemorrhoid vessels. The fibrosis results in attachment of the rectal mucosa to deeper tissues which reduces prolapse.Question: Is it necessary for the whole hemorrhoid tissue to be banded? No, only 1-2 mm of tissue needs to be ligated. The size of the tissue ligated is not important so long as there is enough tissue captured to prevent the band from falling off immediately after it has been applied.Question: How many bands are needed for each hemorrhoid? One band is sufficient for each hemorrhoid. If more than one hemorrhoid requires treatment, additional bands can be applied at one setting or the patient can return for repeat single hemorrhoid banding at 2-3 week intervals.Question: Is the design of the ligator important? The design of the ligator will influence its effectiveness. When used in conjunction with an anoscope, the long slender suction barrel allows for optimal visualization of the hemorrhoid tissue which improves band placement accuracy. Also, the diameter of the barrel tip and the overall configuration of the suction chamber increases the likelihood of only the rectal mucosa being ligated and not the deeper muscle layers. Ligation of the muscle can result in significant pain. DEVICE DESCRIPTION:The inx Medical Nexus Hemorrhoid Ligator is a non-invasive, simple and easy to use disposable device to be used by a physician to apply latex-free rubber bands for the treatment of hemorrhoids. The ligation bands diminish the blood supply to the hemorrhoid resulting in a reduction in the size of the hemorrhoid. The ligation also causes inflammation and fibrosis which causes the rectal mucosa to adhere to deeper tissues which reduces prolapse. It is a hand held device that does not require additional equipment or personnel to operate, and it utilizes an internal plunger mechanism to suck the hemorrhoid tissue into the barrel of the device. The suction mechanism is activated by squeezing a trigger. Once the hemorrhoid tissue is suctioned into the tip of the ligator, a firing trigger is pulled and a band is deployed. The device is pre-loaded with 4 latex-free rubber bands, which will deploy one at a time, allowing the physician to easily treat multiple hemorrhoids during a single procedure.PROCEDURE:Perform a digital rectal exam (DRE) and an anoscopy. Introduce the Nexus Hemorrhoid Ligator through the anoscope into the anus aimed toward the hemorrhoid to be banded. The tip of the ligator should be lightly pressed against the proximal end of the hemorrhoid. The suction trigger is gently squeezed which draws the hemorrhoidal tissue into the tip of the ligator. With the suction trigger compressed, pull and release the band firing trigger to deploy a band onto the hemorrhoid. Release the suction trigger and the ligator is immediately ready to apply additional bands.* I certify that I have read and understand the Nexus Hemorrhoid Ligator Instructions for UseAre you a robot?