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EAST CHESHIRE NHS TRUST Policy for the Prescribing of Domiciliary Oxygen for patients who are Hypoxic and are known Smokers and/or users of cigarettes. Prescribing Domiciliary Oxygen/2014 1 Policy
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How to fill out domiciliary oxygen for patients

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How to fill out domiciliary oxygen for patients:

01
Obtain the necessary forms: Start by acquiring the domiciliary oxygen form from the healthcare provider or the supplier. This form will require specific information about the patient's medical condition and documentation from the prescribing physician.
02
Patient and physician information: Fill out the form with accurate and up-to-date details about the patient, including their name, address, date of birth, phone number, and insurance information. Additionally, provide the complete contact information for the prescribing physician, including their name, address, phone number, and medical license number.
03
Medical documentation: Attach any relevant medical documentation that supports the need for domiciliary oxygen. This may include the physician's prescription, medical records, test results, or any other supporting documentation.
04
Oxygen equipment details: Specify the type of oxygen equipment being requested, such as concentrators, portable tanks, or liquid oxygen systems. Include the necessary details such as quantity, flow rate, and duration of usage.
05
Provide insurance information: If the patient has insurance coverage, provide the necessary information, including the insurance company's name, policy number, and any prior authorizations required.
06
Emergency contacts: Include the contact information for emergency contacts who can be reached in case of any issues or concerns related to domiciliary oxygen use. It's important to have at least two reliable contacts who can be reached at any time.

Who needs domiciliary oxygen for patients?

01
Patients with chronic respiratory conditions: Those suffering from chronic obstructive pulmonary disease (COPD), emphysema, asthma, or other respiratory conditions that cause difficulty in breathing may require domiciliary oxygen.
02
Patients with hypoxemia: Hypoxemia refers to low levels of oxygen in the blood. Individuals with hypoxemia may need domiciliary oxygen to maintain sufficient oxygen levels and prevent complications.
03
Post-surgery or post-trauma patients: Patients who have undergone surgery or experienced trauma that affects their breathing may require domiciliary oxygen during their recovery period.
04
Palliative care patients: Patients in Palliative care or with terminal illnesses may require domiciliary oxygen to alleviate symptoms and improve their quality of life.
05
Patients with sleep apnea: Individuals with sleep apnea, a condition characterized by interrupted breathing during sleep, may need domiciliary oxygen to improve their breathing patterns and ensure proper oxygenation.
Remember, it is crucial to consult a healthcare professional and follow their guidance for accurate assessment and determination of the need for domiciliary oxygen.
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Domiciliary oxygen for patients is the provision of oxygen therapy in the patient's own home to help with respiratory conditions.
Healthcare providers and suppliers are required to file domiciliary oxygen for patients.
Domiciliary oxygen for patients can be filled out by providing the necessary patient information, medical records, and prescription details.
The purpose of domiciliary oxygen for patients is to improve the patient's breathing and quality of life by providing supplemental oxygen.
Information such as the patient's name, medical condition, prescribed oxygen flow rate, and duration of therapy must be reported on domiciliary oxygen for patients.
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