10521 Garden Grove Blvd.Garden Grove, CA 92843Phone: (714) 590-3620 or (877) 590-3620Fax: (714) 590-3628 or (877) 590-3628E-mail: pharmacy@pecrx com
Multi-Cultures Personnel (Vietnamese, Chinese, Korean, Spanish, Japanese, sign language and many others)
General Information:Patient Admission Face Sheet/ Demographic (name, residence or service address, phone, SS#, DOB, ER contact number, language Insurance Coverage, Medication List Height, Weight, Allergy (ies), diagnosis)? A copy of history and physical if applicable.
IV Therapy Information:
Name of Infusion Therapy (drug or enteral) Current Lab Value is desirable.
TPN Patients: CBC, BMP, CMP. IV Antibiotic Patients, *Especially those on Vancomycin or Aminoglycosides (Amikacin, Gent, Tobra.) Drug Levels, CBC. Other lab values are often required for Insurance Authorization. (i.e... CBC for Procrit or Neupogen CPAS)
IV Catheter Access, # of lumen, next dose due time/date
1st DOSE
Some Home Health Agencies will not give a 1st dose in the Home, PEC-HealthCare will usually only administer a 1st dose if before 3pm.Other Injectable Medications: Betaseron, Peg Intron etc..
Physician Information:
Name, phone and general information of the ordering physician. Name, phone and general information of the physician for follow up or signing order thereafter.
IV Therapy Information:
Name of Infusion Therapy (drug or enteral) Current Lab Value is desirable.
TPN Patients: CBC, BMP, CMP. IV Antibiotic Patients, *Especially those on Vancomycin or Aminoglycosides (Amikacin, Gent, Tobra.) Drug Levels, CBC. Other lab values are often required for Insurance Authorization. (i.e... CBC for Procrit or Neupogen CPAS)
IV Catheter Access, # of lumen, next dose due time/date
1st DOSE
Some Home Health Agencies will not give a 1st dose in the Home, PEC-HealthCare will usually only administer a 1st dose if before 3pm.Other Injectable Medications: Betaseron, Peg Intron etc..
Physician Information:
Name, phone and general information of the ordering physician. Name, phone and general information of the physician for follow up or signing order thereafter.