Call: (907) 262-8737
FAX: (907) 260-7405
Physician Information:
Feel confident that we provide quality care to both our patients and our referral sources.
Admission Criteria:
Admission to our home infusion therapy company can only be made under the direction of a physician, based upon the patient's identified care needs, home-bound status (if a payer requirement) and the type of services required that we can provide directly or through coordination with other organizations.
Please provide the following admission paperwork when initiating treatment:
Completed Professional Home IV order form (see below)
H&P
Patient demographics
Allergies
Insurance information
Current medication list
Forms:
Admission Criteria:
Admission to our home infusion therapy company can only be made under the direction of a physician, based upon the patient's identified care needs, home-bound status (if a payer requirement) and the type of services required that we can provide directly or through coordination with other organizations.
- The therapy ordered must be appropriate and safe for home administration.
- The patient must have a telephone available to them for emergency use.
- The home environment must be conducive to safe storage and delivery of the prescribed therapy.
- The patient, family or caregiver must be able to safely demonstrate administration of the treatment following teaching.
Please provide the following admission paperwork when initiating treatment:
Completed Professional Home IV order form (see below)
H&P
Patient demographics
Allergies
Insurance information
Current medication list
Forms:
Home Infusion Order:
| infusion_orders.docx |
Please use link above to download a copy of our infusion orders
You may also use the SCRIBD download below with a free sign up account
You may also use the SCRIBD download below with a free sign up account
If the above links do not work for you try using this pdf
Vivitrol: