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Apheresis Request Form - New York Blood Center - nybloodcenter

Apheresis Request Form - New York Blood Center - nybloodcenter 2025

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The document outlines the Mobile Apheresis Request Form used by Clinical Apheresis Services, detailing the necessary information for scheduling apheresis procedures, including patient details, lab values, procedure types, and fluid replacement requirements. It emphasizes the importance of relevant clinical information and consent for patients undergoing apheresis, as well as guidelines for different types of procedures such as therapeutic plasma exchange and red cell exchange.

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Click ‘Get Form’ to open it in the editor.
Begin by entering the date and start date for the apheresis request. Specify the frequency of procedures and total number of procedures required.
Indicate the priority status by selecting Routine, Urgent, or Emergent based on your needs.
Fill in patient details including name, gender, location, and contact numbers. Provide relevant clinical information and diagnosis as per guidelines.
Input lab values such as Hgb, Hct, Plt, WBC, and others as required for accurate processing.
Select the type of vascular access needed for the procedure from the options provided.
Choose the type of procedure required and fill in any additional orders applicable to ensure comprehensive care.
Finally, review all entries for accuracy before saving or sharing your completed form.

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