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IMMUNOGLOBULIN (IG) THERAPY PRIOR AUTHORIZATION REQUEST PRESCRIBER FAX FORM Only the prescriber may complete this form. This form is for prospective, concurrent, and retrospective reviews. The following

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How to fill out immune globulin ivig and

01

First, wash your hands thoroughly with soap and water.

02

Gather all necessary supplies including the vial of immune globulin IVIG, syringe, and alcohol wipes.

03

Clean the rubber stopper on the vial with an alcohol wipe.

04

Draw air into the syringe by pulling back on the plunger.

05

Insert the needle into the vial and push the air into the vial.

06

Turn the vial upside down and draw the desired amount of immune globulin IVIG into the syringe.

07

Remove any air bubbles by tapping the syringe and pushing the plunger to expel them.

08

Inject the immune globulin IVIG into a vein as directed by your healthcare provider.

09

Dispose of all used needles and syringes in a proper sharps container.

Who needs immune globulin ivig and?

01

People with primary immunodeficiency disorders

02

People with autoimmune disorders

03

People undergoing certain medical treatments like bone marrow transplants or chemotherapy

04

People with certain infections like chronic viral hepatitis

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What is immune globulin ivig and?

Immune globulin IVIG is a medication made up of antibodies that can help to boost the immune system.

Who is required to file immune globulin ivig and?

Healthcare providers are required to file immune globulin IVIG administrations.

How to fill out immune globulin ivig and?

To fill out immune globulin IVIG, healthcare providers must report the dosage, date of administration, and patient information.

What is the purpose of immune globulin ivig and?

The purpose of immune globulin IVIG is to help patients with immune deficiencies boost their immune system.

What information must be reported on immune globulin ivig and?

Information such as dosage, date of administration, and patient information must be reported on immune globulin IVIG.

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