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Virginia Beach City Public Schools: Health Services
PHYSICIANS AUTHORIZATION FOR ENTERAL FEEDING
School Year:
STUDENTS NAME (Last, First):BIRTHDATE:I. PHYSICIAN ORDER
DIAGNOSIS:
Gastrostomy Tube:
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How to fill out enteral feeding authorization form
How to fill out enteral feeding authorization form
01
Obtain the enteral feeding authorization form from the healthcare provider or facility.
02
Fill out the patient's personal information including name, date of birth, and contact details.
03
Provide details of the healthcare provider responsible for prescribing the enteral feeding.
04
Indicate the type of enteral feeding required and the frequency of administration.
05
Sign and date the form to indicate consent and understanding of the enteral feeding authorization.
Who needs enteral feeding authorization form?
01
Patients who require enteral feeding as part of their medical treatment.
02
Healthcare providers who are responsible for prescribing and monitoring enteral feeding therapy.
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What is enteral feeding authorization form?
The enteral feeding authorization form is a document required for the approval of enteral nutrition services and products by healthcare providers, ensuring that patients receive appropriate nutritional support.
Who is required to file enteral feeding authorization form?
Healthcare providers, such as physicians or dietitians, who are prescribing enteral nutrition for their patients must file the enteral feeding authorization form.
How to fill out enteral feeding authorization form?
To fill out the enteral feeding authorization form, provide patient information, physician details, specific nutritional needs, the type of enteral feeding required, and any other relevant medical documentation as requested on the form.
What is the purpose of enteral feeding authorization form?
The purpose of the enteral feeding authorization form is to obtain approval from insurance or health plans for coverage of enteral nutrition services, ensuring patients have access to necessary nutritional support.
What information must be reported on enteral feeding authorization form?
The form must typically include patient demographics, medical history, details of the enteral feeding prescription, duration of therapy, and the provider's contact information.
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