Iron infusion consent form pdf 2025

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  1. Click ‘Get Form’ to open the iron infusion consent form in the editor.
  2. Begin by entering your full name and date of birth in the designated fields. This information is crucial for identifying your medical records.
  3. Fill in your full address accurately to ensure proper communication and follow-up from the medical center.
  4. Review the list of risks associated with FERINJECT carefully. Acknowledge your understanding by signing in the 'Patient Signature' field, followed by today's date.
  5. If applicable, have your doctor sign and date the form in their respective section to validate your consent.
  6. Ensure that a copy of your blood test results is noted as obtained and scanned into your patient file, as indicated on the form.

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Where is an iron infusion administered? An iron infusion is carried out in a medical facility where trained health professionals can effectively manage side effects if any were to occur during or after the infusion. No overnight hospitalisation stay is necessary with iron infusions.
FCM can be administered as a single 750 mg dose via a slow IV push injection over 7.5 minutes or as an IV infusion over at least 15 minutes. The second dose is administered at least 7 days later for a recommended cumulative dose of 1500 mg iron [36].
Iron polymaltose is to be administered by a Registered Nurse. drugs for treatment of anaphylactic reactions are readily available within the patient's vicinity throughout the procedure.
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You will be provided with a prescription for your iron infusion \u2013 this can also be obtained from your referring GP. This prescription can be filled at any pharmacy and will cost around $30 to $40. Bring this to your consultation. Prior to your infusion a cannula will be inserted into a vein in your arm.
Intravenous iron should be considered as first line treatment in patients with clinically active IBD, with previous intolerance to oral iron, with hemoglobin below 10g/dL, and in patients who need erythropoiesis-stimulating agents (ESAs).
You will be provided with a prescription for your iron infusion \u2013 this can also be obtained from your referring GP. This prescription can be filled at any pharmacy and will cost around $30 to $40. Bring this to your consultation. Prior to your infusion a cannula will be inserted into a vein in your arm.
Iron carboxymaltose is to be administered by a Registered Nurse. Facilities for cardio-pulmonary resuscitation must be available. Drugs that must be available are: - Adrenaline 1:10000 10mL Injection - Hydrocortisone sodium succinate Injection 100mg - Promethazine hydrochloride Injection 25mg.
Please let the nurses know at the time if you feel unwell during your iron infusion. The nurse will check your pulse, blood pressure and temperature after the infusion has finished. You will normally be able to go home after 30 minutes.

iron infusion consent form nsw