Top Rated Infusion Specialists in Cleveland & Northeast Ohio
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Login to Patient Portal »Submit a Referral
Submitting a referral for your patient to receive care at Ohio Infusion Services is easy. Click the therapy below, and follow the three simple steps. If you need assistance with the referral process, please call us at 216-381-3333.
We will work closely with you at all points of care by sharing clinical notes, updating you on your patient’s progress, and requesting your prior authorization before making any adjustments to their treatment. Do not hesitate to contact us with any questions or concerns regarding the care of your patient.
Bivigam
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Step #2
Complete the order form(s) for this therapy.
IVIg Autoimmune Referral Form »IVIg Immunology Referral Form »IVIg Neurology Referral Form »
IVIG
When submitting a referral for IVIg therapies, please provide the following information:
- All pertinent notes from most recent office visits
- Detailed infection history
- Tried and failed antibiotic history and/or history of allergies to antibiotics
- Most recent lab results, including any IgG (including sub-class), IgA and IgM levels
- Pneumococcal titers, pre and post (if available)
- Polysaccharide Antigen titers (e.g., meningococcal titers), pre and post (if available)
Gammagard Liquid
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Step #2
Complete the order form(s) for this therapy.
IVIg Autoimmune Referral Form »IVIg Immunology Referral Form »IVIg Neurology Referral Form »
IVIG
When submitting a referral for IVIg therapies, please provide the following information:
- All pertinent notes from most recent office visits
- Detailed infection history
- Tried and failed antibiotic history and/or history of allergies to antibiotics
- Most recent lab results, including any IgG (including sub-class), IgA and IgM levels
- Pneumococcal titers, pre and post (if available)
- Polysaccharide Antigen titers (e.g., meningococcal titers), pre and post (if available)
Liquid 10% Gamunex-C
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Step #2
Complete the order form(s) for this therapy.
IVIg Autoimmune Referral Form »IVIg Immunology Referral Form »IVIg Neurology Referral Form »
IVIG
When submitting a referral for IVIg therapies, please provide the following information:
- All pertinent notes from most recent office visits
- Detailed infection history
- Tried and failed antibiotic history and/or history of allergies to antibiotics
- Most recent lab results, including any IgG (including sub-class), IgA and IgM levels
- Pneumococcal titers, pre and post (if available)
- Polysaccharide Antigen titers (e.g., meningococcal titers), pre and post (if available)
Octagam 5% and 10%
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Step #2
Complete the order form(s) for this therapy.
IVIg Autoimmune Referral Form »IVIg Immunology Referral Form »IVIg Neurology Referral Form »
IVIG
When submitting a referral for IVIg therapies, please provide the following information:
- All pertinent notes from most recent office visits
- Detailed infection history
- Tried and failed antibiotic history and/or history of allergies to antibiotics
- Most recent lab results, including any IgG (including sub-class), IgA and IgM levels
- Pneumococcal titers, pre and post (if available)
- Polysaccharide Antigen titers (e.g., meningococcal titers), pre and post (if available)
Panzyga
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Step #2
Complete the order form(s) for this therapy.
IVIg Autoimmune Referral Form »IVIg Immunology Referral Form »IVIg Neurology Referral Form »
IVIG
When submitting a referral for IVIg therapies, please provide the following information:
- All pertinent notes from most recent office visits
- Detailed infection history
- Tried and failed antibiotic history and/or history of allergies to antibiotics
- Most recent lab results, including any IgG (including sub-class), IgA and IgM levels
- Pneumococcal titers, pre and post (if available)
- Polysaccharide Antigen titers (e.g., meningococcal titers), pre and post (if available)
Privigen
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Step #2
Complete the order form(s) for this therapy.
IVIg Autoimmune Referral Form »IVIg Immunology Referral Form »IVIg Neurology Referral Form »
IVIG
When submitting a referral for IVIg therapies, please provide the following information:
- All pertinent notes from most recent office visits
- Detailed infection history
- Tried and failed antibiotic history and/or history of allergies to antibiotics
- Most recent lab results, including any IgG (including sub-class), IgA and IgM levels
- Pneumococcal titers, pre and post (if available)
- Polysaccharide Antigen titers (e.g., meningococcal titers), pre and post (if available)
Gammaked
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Step #2
Complete the order form(s) for this therapy.
IVIg Autoimmune Referral Form »IVIg Immunology Referral Form »IVIg Neurology Referral Form »
IVIG
When submitting a referral for IVIg therapies, please provide the following information:
- All pertinent notes from most recent office visits
- Detailed infection history
- Tried and failed antibiotic history and/or history of allergies to antibiotics
- Most recent lab results, including any IgG (including sub-class), IgA and IgM levels
- Pneumococcal titers, pre and post (if available)
- Polysaccharide Antigen titers (e.g., meningococcal titers), pre and post (if available)
Cinqair
When submitting a referral for Cinqair, please provide the following information:
- All pertinent notes from most recent office visits
- Clinicals to support diagnosis of severe eosinophilic asthma along with a list of current medications treating the condition
- Lab results showing elevated eosinophil levels
- FEV1 test results
- Proof that the patient is 18 years of age or older
Fasenra
When submitting a referral for Fasenra, please provide the following information:
- All pertinent notes from most recent office visits
- Clinicals to support diagnosis of severe eosinophilic asthma along with a list of current medications treating the condition
- Lab results showing an elevated eosinophil levels
- FEV1 test results
- Clinicals showing the number of asthma exacerbations in the last 12 months
Nucala
When submitting a referral for Nucala, please provide the following information:
- All pertinent notes from most recent office visits
- Clinicals to support diagnosis of severe eosinophilic asthma along with a list of current medications treating the condition
- Lab results showing an elevated eosinophil count of 150 cells/uL or higher
- FEV1 test results
- Clinicals showing the number of asthma exacerbations in the last 12 months
Orencia
When submitting a referral for Orencia, please provide the following information:
- All pertinent notes from most recent office visits
- Patient's current weight and height
- Clinicals to support diagnosis of one or more of the following conditions:
- Rheumatoid arthritis (RA)
- Juvenile idiopathic arthritis (JIA)
- Psoriatic arthritis
Remicade
When submitting a referral for Remicade, please provide the following information:
- All pertinent notes from most recent office visits
- Results of a recent tuberculosis (TB) skin/lab testing
- Patient’s current weight and height
- Clinicals to support diagnosis of one or more of the following conditions:
- Active moderate to severe Crohn’s disease (CD)
- Active moderately to severely active ulcerative colitis (UC)
- Rheumatoid arthritis (RA)
- Psoriatic arthritis
- Ankylosing spondylitis
- Plaque psoriasis
Rituxan
When submitting a referral for Rituxan, please provide the following information:
- All pertinent notes from most recent office visits
- Patient's current weight and height
- Clinicals to support that the patient has moderately to severely active rheumatoid arthritis (RA) and/or multiple sclerosis (MS) and is currently taking methotrexate
Simponi Aria
When submitting a referral for Simponi Aria, please provide the following information:
- All pertinent notes from most recent office visits
- Results of a recent Tuberculosis (TB) skin/lab testing
- Patient's current weight and height
- Clinicals to support diagnosis of one or more of the following conditions:
- Moderately to severely active rheumatoid arthritis (RA) that is currently being treated with methotrexate
- Active psoriatic arthritis
- Active ankylosing spondylitis
Xolair
When submitting a referral for Xolair, please provide the following information:
- All pertinent notes from most recent office visits
- Lab results of IgE test
- Clinicals to support one or both of the following:
- Patient is 6 years of age or older with moderate to severe persistent asthma that is not adequately controlled with inhaled corticosteroids and has had a positive skin test or in vitro reactivity to a perennial aeroallergen
- Patient is 12 years of age or older with chronic idiopathic urticaria (CIU) that is not adequately controlled with H1 histamine treatments
- FEV1 test results
HyQvia
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Step #2
Complete the order form(s) for this therapy.
Autoimmune Referral Form »Immunology Referral Form »Neurology Referral Form »
Ig
When submitting a referral for Ig therapies, please provide the following information:
- All pertinent notes from most recent office visits
- Detailed infection history
- Tried and failed antibiotic history and/or history of allergies to antibiotics
- Most recent lab results, including any IgG (including sub-class), IgA and IgM levels
- Pneumococcal titers, pre and post (if available)
- Polysaccharide Antigen titers (e.g., meningococcal titers), pre and post (if available)
Don't see your therapy listed? Contact us for more information. We are constantly expanding our treatments to meet the needs of our patients.