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State of Rhode Island Executive Office of Health and Human Services Medicaid Program CERTIFICATE OF MEDICAL NECESSITY EXTERNAL INFUSION PUMP SECTION A Certification Date: PATIENT NAME, ADDRESS, TELEPHONE
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How to fill out external infusion pump

How to fill out an external infusion pump:
01
Ensure that you have gathered all the necessary supplies, including the medication or fluids to be infused, the infusion pump, IV tubing, and any other required accessories.
02
Clean your hands thoroughly with soap and water, or use hand sanitizer if soap and water are not available.
03
Prepare the medication or fluids according to the instructions provided by your healthcare provider or pharmacist. This may involve diluting the medication or mixing it with a compatible solution.
04
Connect the IV tubing to the medication bag or bottle, ensuring a secure connection.
05
Prime the tubing by flushing it with the medication or solution, removing any air bubbles from the tubing.
06
Follow the manufacturer's instructions to properly program the infusion pump. Set the appropriate flow rate, volume, and any other parameters as instructed.
07
Open the clamp on the tubing, if applicable, to allow the medication or fluids to flow through the tubing.
08
Connect the tubing to the infusion pump, making sure it is securely attached.
09
Position the infusion pump in a safe and convenient location, such as hanging it on an IV pole or placing it on a stable surface.
10
Start the infusion by activating the pump according to the manufacturer's instructions. Monitor the flow rate and adjust as necessary to maintain the desired infusion rate.
11
Regularly check the infusion site and tubing for any signs of complications or blockages. Report any concerns to your healthcare provider.
12
When the infusion is complete, properly dispose of any used supplies according to healthcare waste management guidelines.
Who needs an external infusion pump:
01
Individuals who require long-term administration of medication or fluids, such as chemotherapy drugs, pain management medications, or hydration therapy, may need an external infusion pump.
02
Patients with conditions that affect their ability to swallow or absorb medication orally, or those who need precise control over the rate and dosage of medication delivered, may also benefit from an external infusion pump.
03
External infusion pumps can be used in various healthcare settings, including hospitals, clinics, and home care, to provide continuous or intermittent infusions for patients in need.
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What is external infusion pump?
An external infusion pump is a medical device used to deliver fluids into a patient's body in a controlled manner.
Who is required to file external infusion pump?
Manufacturers, distributors, and importers of external infusion pumps are required to file with regulatory agencies.
How to fill out external infusion pump?
External infusion pumps must be filled out with accurate information about the device and its intended use.
What is the purpose of external infusion pump?
The purpose of an external infusion pump is to deliver medications or fluids in a controlled and precise manner to patients.
What information must be reported on external infusion pump?
Information such as device specifications, intended use, manufacturing details, and any reported incidents must be reported on external infusion pumps.
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