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Ambulatory Outpatient Infusion Orders

Ordering Process

  1. Locate the needed order set below and print.
  2. Review the order set to ascertain any labs or additional prep is completed prior to sending referral. Orders from here contain all of the information needed (if blanks are filled in properly).Note: there are multiple pages of orders included to access.
  3. Once order set is printed, it should be completely filled out by provider. Please print provider name beneath signature on all orders.
  4. Follow your office process for obtaining prior authorizations needed for treatment:
    1. Include insurance prior authorization reference number or for “no auth required” document contact’s name & phone number. Documentation from the insurance company is preferred.
    2. Ensure that prior authorizations are completed for medical coverage for treatment at the facility as well as drug coverage. If the patient requires use of pharmacy benefit coverage, this will have to be authorized for drug and facility coverage separately.
  5. Fax orders, any appropriate consents, patient face sheet and insurance information, applicable labs, and patient medication list to our Outpatient Center at 337.430.6976. Include office contact person, phone and fax numbers with the orders.
  6. For further information or assistance call the Ambulatory Outpatient Infusion Center at 337.494.4750.
  7. Once orders are received, they will be processed by infusion nurses and patients will be scheduled within 7 days of insurance authorization and verification process.
  8. Provider is notified of patient receipt of treatment via fax with patient flow sheet by fax.
  9. Use checklist provided here to ensure timely scheduling of your patients once all items received.

For further information or assistance call the Outpatient Infusion Center at 337.494.4750.

Available Order Sets

Actemra (Tocilizumab) for Rheumatoid Arthritis

Blank Order Set


Intravenous Immunoglobulin (IVIG)

Pegloticase (Krystexxa)

Abatacept (Orencia)



Line Flush/IV Line

ESA Agents




Chemotherapy Supportive Care


riTUXimab (Rituxan)

Golimumab (Simponi ARIA)



Systemic Lupus Erythematosus


Cosyntropin Stimulation Test

Tuberculin Skin Testing