We welcome referrals from our Community Care Physicians’ (CCP) network and also non-CCP community providers. Thank you for trusting us with your patients’ infusions. As a reminder, we infuse the medications but do not directly manage your patients’ conditions. Contact us for more information or for any questions.
To refer a patient for infusion:
For non-CCP providers: complete the below and fax as directed with the requested information.
- Complete infusion order, including current patient demographics.
- Attach a copy of insurance information prescription/medical card(s), front and back.
- Provide most updated clinical progress notes, labs, tests, or imaging supporting primary diagnosis.
- Provide details of tried and failed medications, respective treatment duration, and reason for discontinuation.
For CCP providers: please complete the referral process in our shared electronic health record.
To ensure a smooth infusion process, we kindly request the following from ordering providers:
- Evaluation of patient for therapy appropriateness
- Orders for infused medication (internal and external paths)
- Obtain and evaluate pre-infusion lab values
- Orders for pre-infusion medications
- Obtain and attach informed consent from the patient
- Corresponding follow-ups after the infusion
- If off-label indication, include a letter of medical necessity with progress note
ALL Orders
- Signed Consent: A signed consent is needed for any patient being referred to the infusion center. The consent for the medication and treatment is good for 1 year.
- Approval / Anaphylaxis Protocol: The referral order will ask you to approve the medications included in the Infusion Center protocol.
- Dosage and Frequency: This must be indicated in the order.
Order Prerequisites:
For Stelara, Benlysta, Skyrizi, Entyvio, Stelara, Simponi, Saphnelo, Orencia, Cimzia, Actemra, Ocrevus
- Hepatitis B non-reactive
- Hepatitis C non-reactive
- Tuberculosis screening – negative
For Prolia, Zoledronic Acid, Evenity
- Serum CA WNL within 2 months
- CrCL > 25ml/min
- Serum 25-hydroxy vitamin D > 30ng/ml
For Remicade, Ruxience, Rituxan, Renflexis
- Hepatitis B non-reactive
- Hepatitis C non-reactive
- Tuberculosis screening – negative and
Indications of dosage for the following: diphenhydramine, methylprednisolone and acetaminephen
