Get the free Outpatient Infusion Center Referral Forms

Kettering Health Infusion Center Washington Township 1989 MiamisburgCenterville Rd Suite 101 Dayton, OH 45459 Phone: 9374016625 Fax: 9374016628Tezspire (Tezepelumab) Order Form EPIC Referral Reference:

How to fill out outpatient infusion center referral

How to fill out outpatient infusion center referral

1. Obtain a referral form from your healthcare provider or from the outpatient infusion center.
2. Fill out your personal information including your full name, date of birth, contact information, and insurance details.
3. Provide details about your medical condition that requires infusion therapy, including the diagnosis and any relevant medical history.
4. Indicate the preferred date and time for your infusion appointment, if applicable.
5. If you have any specific preferences or requirements for the infusion center, such as the choice of medication or any special accommodations, make sure to mention them.
6. Ensure that all required sections are completed accurately and legibly.
7. Submit the filled-out referral form to the outpatient infusion center either in person, by mail, or through electronic means as instructed.
8. Keep a copy of the referral form for your records and follow up with the infusion center to confirm receipt and schedule your appointment.

Who needs outpatient infusion center referral?

1. Individuals who require infusion therapy as part of their medical treatment or management may need an outpatient infusion center referral.
2. This includes patients with conditions such as autoimmune diseases, cancer, hematological disorders, infectious diseases, gastrointestinal disorders, or other chronic illnesses.
3. The referral is typically issued by healthcare providers, such as primary care physicians, specialists, or hospital teams, who determine the need for infusion therapy based on the patient's medical condition.

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What is outpatient infusion center referral?

Outpatient infusion center referral is a formal request made by a healthcare provider to refer a patient to an outpatient infusion center for the administration of medications or treatments that require intravenous delivery.

Who is required to file outpatient infusion center referral?

Typically, healthcare providers such as physicians, nurse practitioners, or physician assistants who are managing the patient's care are required to file outpatient infusion center referrals.

How to fill out outpatient infusion center referral?

To fill out an outpatient infusion center referral, the referring provider needs to complete a referral form that includes patient information, the specific treatment required, medical history, and any necessary insurance details.

What is the purpose of outpatient infusion center referral?

The purpose of an outpatient infusion center referral is to ensure patients receive the appropriate intravenous medication treatment in a controlled and supervised environment by specialized healthcare professionals.

What information must be reported on outpatient infusion center referral?

The information that must be reported on an outpatient infusion center referral includes the patient's demographics, diagnosis, treatment plan, medications prescribed, and any pertinent medical history.