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SUBCUTANEOUS IMMUNE GLOBULIN NEUROLOGY REFERRAL FORM Fax referral to: 8448141944 Phone: 8448141943 Email referral form to: connect@realospecialtycare.com For additional forms, visit realospecialtycare.com.
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How to fill out intravenous immune globulin referral
How to fill out intravenous immune globulin referral
01
Consult with a healthcare provider to assess the need for intravenous immune globulin (IVIG) therapy.
02
Complete the necessary patient demographic information on the IVIG referral form.
03
Provide relevant medical history, diagnosis, and reason for requesting IVIG therapy.
04
Include any supporting documentation such as lab results or previous treatments.
05
Obtain authorization from insurance or healthcare provider before submitting the referral.
Who needs intravenous immune globulin referral?
01
Patients with immunodeficiency disorders such as primary immunodeficiency diseases.
02
Patients with autoimmune disorders where IVIG therapy is a recommended treatment option.
03
Patients with certain neurological conditions like Guillain-Barre Syndrome or Chronic Inflammatory Demyelinating Polyneuropathy.
04
Patients undergoing bone marrow or stem cell transplants.
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What is intravenous immune globulin referral?
Intravenous immune globulin referral is a process where a healthcare provider recommends a patient to receive intravenous immune globulin therapy.
Who is required to file intravenous immune globulin referral?
Healthcare providers such as doctors or specialists are required to file intravenous immune globulin referral.
How to fill out intravenous immune globulin referral?
To fill out intravenous immune globulin referral, healthcare providers need to include patient information, medical history, reason for therapy, and dosage recommendations.
What is the purpose of intravenous immune globulin referral?
The purpose of intravenous immune globulin referral is to provide patients with a treatment option for conditions that require immune system support.
What information must be reported on intravenous immune globulin referral?
Information such as patient demographics, medical history, diagnosis, current medications, treatment plan, and dosage instructions must be reported on intravenous immune globulin referral.
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