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Keene medical products, inc. physician's order for enteral... 2025

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56 votes

The document from Keene Medical Products, Inc. outlines the requirements and guidelines for enteral feeding orders, emphasizing the need for physician signatures, patient demographics, and medical documentation. It details criteria for enteral nutrition coverage, including specific medical conditions that necessitate tube feeding, and provides a list of common ICD codes related to these conditions. Additionally, it specifies the types of enteral formulas and equipment required for effective administration.

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Click ‘Get Form’ to open it in the editor.
Begin by entering the patient's name and date of birth in the designated fields. Ensure accuracy as this information is crucial for identification.
Fill in the supporting diagnosis and ICD code. This section is vital for insurance purposes and must reflect the patient's medical condition.
Select the type of feeding tube required (NG Tube, G Tube, J Tube) and provide the height and weight of the patient. This data helps determine appropriate feeding requirements.
Complete the order date, discharge date, and room number if applicable. These details assist in tracking patient care.
Specify daily calorie requirements, formula prescription, enteral product, and method of administration (Syringe, Pump, Oral, Gravity). Each choice impacts nutritional delivery.
Indicate if equivalent formula per Keene Medical RD is acceptable and fill in rate of administration along with water flush details.
Finally, ensure that a physician's signature is obtained along with their name and NPI number to validate the order.

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Versions	Form popularity	Fillable & printable
2022	4.5 Satisfied (35 Votes)
2014	4 Satisfied (56 Votes)

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