Special Procedures Unit and Infusion Clinic referral documents

Referral forms

• Infusion Center and Special Procedures Clinic Referral Form (pdf)

Therapy plans

• Abatacept Therapy Plan (pdf)

• Abatacept (ORENCIA) (SOTP) Infusion Therapy Plan (pdf)

• Abobotulinumtoxina (DYSPORT) Injection Therapy Plan (pdf)

• Agalsidase Beta (Fabrazyme) Infusion Therapy Plan (pdf)

• Albumin (Heart Failure) Infusion Therapy Plan (pdf)

• Albumin (SOTP) Infusion Therapy Plan (pdf)

• Alglucosidase (Lumizyme) Infusion Therapy Plan (pdf)

• Alteplase Therapy Plan (pdf)

• AVALglucosidase Alpha (NEXVIAZYME) Infusion Therapy Plan (pdf)

• Belatacept Therapy Plan (pdf)

• Belimumab (BENLYSTA) Infusion Therapy Plan (pdf)

• Bortezomib (VELCADE) Injection Therapy Plan (pdf)

• Casimersen (AMONDYS 45) Infusion Therapy Plan (pdf)

• Chorionic Gonadotrophin (hCG) Injection Therapy Plan (pdf)

• Cyclophosphamide Infusion Therapy Plan (pdf)

• Dermatology Rituximab Infusion Therapy Plan (pdf)

• Dihydroergotamine (DHE) Infusion Therapy Plan (pdf)

• Eculizumab Therapy Plan (pdf)

• Eculizumab (SOLIRIS) Therapy Plan (pdf)

• Elosulfase (Vimizim) Infusion Therapy Plan (pdf)

• Endocrinology Zoledronic Acid (ZOMETA) Infusion Therapy Plan (pdf)

• Ferric Carboxymaltose Infusion Therapy Plan (pdf)

• Ferric Gluconate Therapy Plan (pdf)

• Galsulfase Therapy Plan (pdf)

• Glucose Tolerance Test Infusion Therapy Plan (pdf)

• Histrelin (SUPPRELIN LA) Implant Therapy Plan (pdf)

• Hydroxocobalamin Injection Therapy Plan (pdf)

• Idursulfase (ELAPRASE) Infusion Therapy Plan (pdf)

• Imiglucerase (CEREZYME) Infusion Therapy Plan (pdf)

• Infliximab Biosimilar (INFLECTRARENFLEXIS) GI Therapy Plan (pdf)

• InFLIXimab (REMICADE) (GI) Therapy Plan (pdf)

• InFLIXimab (REMICADE) (Rheumatology) Therapy Plan (pdf)

• InFLIXlimab (REMICADE or BIOSIMILAR) (Ophthalmology)Therapy Plan (pdf)

• Intravenous Immunoglobulin (IVIG) (Immunology) Therapy Plan (pdf)

• Intravenous Immunoglobulin (IVIG) (Neurology) Therapy Plan (pdf)

• Intravenous Immunoglobulin (IVIG) (Neurology) Tapering Infusion Therapy Plan (pdf)

• Intravenous Immunoglobulin (IVIG) (Rheumatology) Infusion Therapy Plan (pdf)

• Intravenous Immunoglobulin (IVIG) (SOTP) Infusion Therapy Plan (pdf)

• Iron Sucrose Infusion Therapy Plan (pdf)

• Iron Sucrose (VENOFER) Infusion Therapy Plan (GI) (pdf)

• Iron Sucrose (VENOFER) Infusion Therapy Plan (SOTP) (pdf)

• Laronidase (Aldurazyme) Infusion Therapy Plan (pdf)

• Leuprolide (LUPRON DEPOT) Injection Therapy Plan (pdf)

• Medroxyprogesterone (DEPO-PROVERA) Injection Therapy Plan (pdf)

• Methylprednisolone (SOLUMEDROL) (Rheumatology) Infusion Therapy Plan (pdf)

• Methylprednisolone (SOLUMEDROL) (SOTP) Infusion Therapy Plan (pdf)

• Natalizumab (TYSABRI) Infusion Therapy Plan (pdf)

• Nephrology Rituximab Infusion Therapy Plan (pdf)

• Nephrology Zoledronic Acid (ZOMETA) Infusion Therapy Plano (pdf)

• Neurology Infliximab Infusion Therapy Plan (pdf)

• Neurology Rituximab Infusion Therapy Plan (pdf)

• Nusinersen (Spinraza) Injection Therapy Plan (pdf)

• Ocrelizumab (OCREVUS) Infusion Therapy Plan (pdf)

• Omalizumab Therapy Plan (pdf)

• Onabotulinumtoxina (BOTOX) Injection Therapy Plan (pdf)

• Onasemnogene Abeparvovec (ZOLGENSMA) Infusion Therapy Plan (pdf)

• Palivizumab (SYNAGIS) Injection Therapy Plan (pdf)

• Pamidronate Infusion Therapy Plan (pdf)

• Pentamidine Infusion Therapy Plan (pdf)

• Rheumatology Infliximab Infusion Therapy Plan (pdf)

• Rituximab Nephrology Therapy Plan (pdf)

• Rituximab Neurology Therapy Plan (pdf)

• Rituximab Rheumatology Therapy Plan (pdf)

• SOTP Rituximab Infusion Therapy Plan (pdf)

• Testosterone Injection Therapy Plan (pdf)

• Tocilizumab (ACTEMRA) Infusion Therapy Plan (pdf)

• Triptorelin (TRIPTODUR) Injection Therapy Plan (pdf)

• Ustekinumab (STELARA) Infusion Therapy Plan (pdf)

• Vedolizumab (ENTYVIO) Therapy Plan (pdf)

• Velaglucerase Alfa (VPRIV) Infusion Therapy Plan (pdf)

• Zoledronic Acid (Endo)Therapy Plan (pdf)

Stimulation tests

• Cosyntropin Stimulation Test (pdf)

• Growth Hormone (Arginine/Clonidine) Stimulation Test (pdf)

• Growth Hormone (Arginine/L-DOPA) Stimulation Test (pdf)

• Growth Hormone (Clonidine/L-DOPA) Stimulation Test (pdf)

• Leuprolide Stimulation Test (pdf)

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