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Referral for Pasteurized Donor Milk (PM) for Discharge Copies of this form are not accepted at SPD Use originals only For DISCHARGE use ONLY SUBJECT TO AVAILABILITY NO RETURNS NONTRANSFERABLE Checklist

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How to fill out dispensing pasteurized donor milk

01

Thaw the pasteurized donor milk in the refrigerator overnight.

02

Gently swirl the milk to mix the cream back in.

03

Warm the milk by placing the container in a bowl of warm water. Do not microwave.

04

Fill out the necessary information on the dispensing form, such as date, time, amount of milk, and recipient details.

05

Transfer the milk into a clean, sterilized bottle using a funnel.

06

Cap the bottle securely and label it with the date and time of expression.

Who needs dispensing pasteurized donor milk?

01

Infants who are unable to breastfeed or receive milk from their own mother.

02

Premature babies who require additional nutrition and antibodies.

03

Babies with special medical needs or allergies to formula.

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What is dispensing pasteurized donor milk?

Dispensing pasteurized donor milk is the process of providing donor milk that has been pasteurized to ensure safety for consumption.

Who is required to file dispensing pasteurized donor milk?

Any facility or organization that dispenses pasteurized donor milk is required to file this information.

How to fill out dispensing pasteurized donor milk?

To fill out dispensing pasteurized donor milk, one must provide detailed information about the donor milk being dispensed, the recipient, and the date of dispensing.

What is the purpose of dispensing pasteurized donor milk?

The purpose of dispensing pasteurized donor milk is to provide a safe and healthy alternative for infants who cannot consume mother's milk.

What information must be reported on dispensing pasteurized donor milk?

The information that must be reported on dispensing pasteurized donor milk includes details of the donor milk, recipient, date of dispensing, and any relevant medical information.

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