Page 177 - Business Development Orientation Binder

4/9/2019

Infusion Checklist Summary
Please ensure that all of these items are obtained/documented when applicable
 Ordering Infusion MD Name Documented
 MD Following Infusion in the Community Documented
 Name of Pharmacy documented
 Infused Medication documented
 1 Dose given documented
st
 Drug Scripts from MD
 Insertion Report
 Caregiver is known and documented
 Pharmacy Orders Obtained (per DOH Regulation)
 Lab Levels (Chemistry and CBC)‐ (If available)
 Trough Level w/ BUN/ Cr Documented (If applicable)
 Face to Face form
 Mutual Care Agreement
 Consent Form (If applicable)

10

Summary of the Infusion Workflow

10

10