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Enteral Discharge Fax Referral Form - Providence-Oregon A - oregon providence 2026
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- Click ‘Get Form’ to open it in the editor.
- Begin by entering the patient's name, including last name, first name, and middle initial, along with their date of birth.
- Indicate the estimated length of need for tube feeding by selecting one of the options provided: less than 3 months, 3 months, 6 months, 12 months, or lifetime. If less than 3 months is selected, specify the number of weeks needed.
- Fill in the patient's height and weight as required.
- Complete the tube feeding order section by answering whether substitutions for pediatric products are allowed and specifying if an equivalent formula may be substituted for adults.
- Select the type of oral diet and specify if it is ready to feed, powder, or concentrate. Also indicate the daily flush and free water requirements.
- Choose the method of administration (syringe/bolus, gravity, or pump) and provide details on goal rates or volumes at discharge.
- Finally, ensure that all sections are completed accurately before saving your work and sending it via fax to the appropriate numbers listed at the bottom of the form.
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| 2008 | 4.8 Satisfied (109 Votes) |
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The system fills in most of the physicians discharge order form. It supplies information for referrals to outside institutions, and provides a variety of
Mar 21, 2025 also used Providence to provide DME for my respiratory and enteral supplies. Recently that changed to a private supplier, Option Care Health.Read more