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.

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.

Please fax completed order forms to the infusion center where the patient will be receiving treatment.

Lab Orders
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.

Kaiser Permanente Infusion Locations

Revised 11/21/2016