WHEN REFERRING A PATIENT, PLEASE INCLUDE THE FOLLOWING DOCUMENTS:*
Copy of insurance cards (front & back)Patient Demographic SheetPhysicians order and Pre medsMost recent H&P, Medical Notes, Infusion NotesPatient Demographic SheetRelevant Labs (please include autoimmune panelDiagnostic ResultsLatest Tb ResultRecent Medication ListPatient Weight

ATTACH CHECKLIST DOCUMENTS HERE OR FAX TO 805-449-4224*

*Once all information is received, we will attempt to get your patient on our infusion schedule within 5-7 days.*