IV Iron (, , ) Infusion Therapy Plan Orders Review orders and note changes; fax completed order form 2025

1. Click ‘Get Form’ to open the IV Iron Infusion Therapy Plan Orders in the editor.
2. Begin by entering the patient's name and Group Health Member I.D. # at the top of the form.
3. Fill in the Date of Birth and Order Date, followed by the patient's weight and height.
4. Select the appropriate diagnosis from the provided options, ensuring to note any changes if necessary.
5. In the General Plan Communication section, add any special instructions or notes relevant to the patient’s treatment.
6. Complete the Provider Information section with your signature, printed name, phone number, and fax number.
7. Review all entries for accuracy before proceeding to fax the completed order form to the designated infusion center using our platform's fax feature.

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