Enteral Discharge Fax Referral Form - Providence-Oregon A - oregon providence 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the patient's name, including last name, first name, and middle initial, along with their date of birth.
3. 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.
4. Fill in the patient's height and weight as required.
5. 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.
6. 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.
7. Choose the method of administration (syringe/bolus, gravity, or pump) and provide details on goal rates or volumes at discharge.
8. 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.

Start using our platform today to streamline your form completion process for free!