Get Therapeutic Phlebotomy Order Form
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How to fill out the Therapeutic Phlebotomy Order Form online
Completing the Therapeutic Phlebotomy Order Form online can be straightforward if you follow the right steps. This guide offers detailed instructions to ensure that you fill out the form correctly and efficiently.
Follow the steps to fill out the form accurately.
- Press the ‘Get Form’ button to access the Therapeutic Phlebotomy Order Form and open it in your web browser.
- Begin by entering the patient's name in the designated field to ensure proper identification.
- Next, fill in the patient's date of birth (DOB) in the appropriate section.
- Provide the pre-authorization number. It is important to note that the ordering physician’s office is responsible for obtaining any necessary authorizations or referrals.
- If you have questions about pre-authorizations, you can contact Katie Jones at the provided phone number or email for assistance.
- Input the diagnosis to clarify the medical reason for the therapeutic phlebotomy.
- Complete the ICD-9 code section to correctly classify the diagnosis.
- In the lab orders section, check the appropriate tests that need to be conducted, including Peripheral, CBC, Ferritin, and Hct.
- Specify the amount of blood to be drawn. Indicate if it is a one-time procedure or if more is needed based on weekly, monthly, or other specified frequency.
- For duration of treatment, indicate how long the therapeutic phlebotomy will be required, noting that recurrent orders must be updated annually.
- Select the conditions for minimum hemoglobin (Hgb) and ensure compliance with outlined criteria.
- Provide any special instructions or precautions, such as fluid replacement, if applicable.
- Obtain the physician's signature, ensuring all details are filled out before signing.
- Finally, add the physician's printed name, phone number, and fax number to complete the form.
- Once all sections are filled out, you can save changes, download, print, or share the form as necessary.
Start filling out the Therapeutic Phlebotomy Order Form online today for prompt and efficient documentation.
Performing therapeutic phlebotomy requires following a series of steps to ensure the safety and comfort of the patient. Begin by verifying the patient's identity and obtaining informed consent, then proceed with the procedure using sterile techniques. A Therapeutic Phlebotomy Order Form can guide you through the entire process by outlining the necessary steps and ensuring that all information is documented. This organized method not only enhances patient safety but also optimizes workflow for healthcare providers.
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