Ambulatory infusion therapy
Kaiser Permanente provides infusion services at seven ambulatory clinics throughout Washington. Many specialty infusion medications require supplemental orders to ensure safe administration of these medications during a nurse visit.
Kaiser Permanente infusion locations
Infusion therapy order forms
Contracted specialists must use one of the following forms based on a standardized protocol to order one of these medications for administration at a Kaiser Permanente medical office. These forms were developed based on clinical evidence and best practice recommendations for administering these treatments. These forms are in print-friendly PDF format.
Fax completed order forms to the infusion center where the patient will be receiving treatment.
Lab orders are not included on the infusion therapy request form; place orders via usual method. Lab monitoring is the responsibility of the ordering physician.