Services
- Dermatology Referral Form (PDF, opens in a new tab)
Dermatology
5 medications and therapies listed- Enbrel
- Humira
- Stelara
- Glucocorticoids
- Remicade
- Nephrology Referral Form (PDF, opens in a new tab)
Nephrology
5 medications and therapies listed- Intradialytic parenteral nutrition (IDPN)
- Antibiotics and anti infectives
- Lupron depot
- Iron replacement
- Epoetin and other growth factors.
- How to refer for Nursing
Nursing
7 medications and therapies listed- Assessment
- Skilled Nurses for High tech Infusions
- Pain Management
- Intravenous Catheter Care
- Lab draws
- PICC insertion and maintenance
- Wound care
- How to refer for Pain management
Pain management
5 medications and therapies listed- Adjuncts
- Dosage Management
- Intravenous Cathter
- Palliative Care
- PCA
- Neurology Misc Referral Form (PDF, opens in a new tab)
Neurology
7 medications and therapies listed- Avonex
- Betaseron
- Copaxone
- Immunoglobulins (IVIG)
- Solu-Medrol
- Interavenous Catheter Care
- Adjuncts and Parenteral Dosage Forms
- Gastroenterology Referral Form (PDF, opens in a new tab)
Gastroenterology
6 medications and therapies listed- Cimzia
- Entyvio
- Humira
- Remicade (infliximab)
- Simponi
- Parenteral nutrition (TPN) & (PPN)
- Oncology Referral Form (PDF, opens in a new tab)
Hematology/
10 medications and therapies listedOncology - Adjuctions and Supportive Therapy
- Blood Cell Growth Factors
- Chelation Therapy
- Chemotherapy
- Enteral and Nutritional Support
- Hydration
- Intravenos Catheter Care
- Iron Infusions
- Osteoporpsis and Hypercalcemia Therapy
- TPN & PPN
- Rheumatology Referral Form (PDF, opens in a new tab)
Rheumatology
12 medications and therapies listed- Rituxan (rituximab)
- Remicade
- Reclast (zoledronic acid)
- Prolia
- Orencia
- Immunoglobulins (IVIG)
- Humira
- Forteo
- Enbrel
- Cimzia
- Actemra
- Boniva
- How to refer for Infectious disease
Infectious disease
7 medications and therapies listed- All IV antibiotics
- Infergen
- Interferon
- Intron
- Ribavirin
- Roferon
- Wound care
- How to refer for Transplant
Transplant
7 medications and therapies listed- Blood Cell Growth Factors
- Hydration
- Immunoglobulins (IVIG)
- Intravenous Catheter Care
- Intravenous & antinfectives
- Nutritional support- intravenous (TPN) and Enteral
- Supportiive Therapies
Send a referral
Intake handles benefits investigation, prior authorization and scheduling.
Send a referralFax
(844) 671-2601
Send a completed referral form