St. Joseph Outpatient Infusion Center
How to Refer a Patient
If you are not a PeaceHealth Medical Group provider, the following elements are required before we can process your order and schedule your patient for treatment.
Please provide the following information, to the St. Joseph Outpatient Infusion Center team:
- Recent progress notes from the ordering provider
- Relevant laboratory results and other supporting documentation
- Official Insurance documentation with the authorization number or reference number
- Complete orders (please use the PeaceHealth-approved paper orders)
- Blood Consents need to be signed by ordering provider, and are valid for the duration of the transfusion order, until the order is changed, or until the diagnosis changes
To send an order to the Infusion Center:
- Locate an infusion order linked below
- Typical brand names are bracketed for reference. Orders contain preferred products.
- Click to open or download the PDF. (Important! Please use either MS Edge or Google Chrome)
- Print the PDF and fill in to complete all fields.
- FAX the infusion order to 360-738-6381
Infusion order forms
- Abatacept (Orencia)
- Darbepoetin
- Denosumab (Prolia)
- Denosumab (Xgeva)
- Epoetin
- Evenity (Romosozumab-AQQG)
- General infusion smart set
- Golimumab (Simponi Aria)
- Hydration therapy
- Immune globulin (IVIG)
- Infliximab
- Iron sucrose (Venofer)
- Iron (Injectafer)
- Line care
- Methylpredinosolone
- Ocrelizumab (Ocrevus)
- Octreotide acetate (Sandostantin Lar)
- Rabies
- Blood product transfusion orderset
- Therapeutic phlebotomy
- Therapy plan
- Usetekinumab (Stelara)
- Vedolizumab (Entyvio)
- Zoledronic acid (Reclast)