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Physician Orders THERAPEUTIC PHLEBOTOMY ADULT, OUTPATIENT, INFUSION CENTERPatient Name DOB MAN Physician FIN Page 1 of 2THERAPEUTIC PHLEBOTOMYversion 7/16/2020Defaults for orders not otherwise specified
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How to fill out physicians orders formrapeutic phlebotomy

01
Obtain a copy of the physician's orders form for therapeutic phlebotomy.
02
Fill in the patient's personal information, including name, date of birth, and contact information.
03
Consult with the patient's physician to determine the specific instructions for the therapeutic phlebotomy procedure.
04
Fill out the section of the form that includes the frequency and duration of the phlebotomy sessions.
05
Provide any additional information requested on the form, such as the reason for the therapeutic phlebotomy and any special precautions or considerations.
06
Review the completed form for accuracy and completeness.
07
Submit the filled out form to the appropriate department or healthcare provider administering the therapeutic phlebotomy.

Who needs physicians orders formrapeutic phlebotomy?

01
Patients who require therapeutic phlebotomy as a part of their medical treatment or management.
02
This may include individuals with conditions such as hemochromatosis, polycythemia vera, or iron overload disorders.
03
The necessity of a physician's order for therapeutic phlebotomy will depend on the specific healthcare facility or jurisdiction's regulations.
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Physicians orders for therapeutic phlebotomy refer to a medical directive issued by a physician that authorizes the procedure of drawing blood for therapeutic purposes, often to treat conditions like hemochromatosis or polycythemia vera.
The physician who prescribes the therapeutic phlebotomy is responsible for filing the orders, along with the healthcare facility or laboratory performing the procedure.
The form should be filled out by the physician, indicating the patient's details, the reason for the procedure, the frequency of phlebotomy sessions, and any specific instructions or conditions related to the treatment.
The purpose is to document the physician's directive for performing therapeutic phlebotomy, ensuring proper patient care and adherence to medical protocols.
The form must include patient identification, physician details, diagnosis or reason for phlebotomy, treatment plan, and any relevant lab results or notes regarding the patient's condition.
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