Sample Physician Order Forms
Have a question or want to place an order? Southern California: (877) 429-4472
Mid-Atlantic: (800) 483-4888
Mid-Atlantic: (800) 483-4888
To request a therapeutic apheresis procedure, the physician must prepare and sign physician orders for therapeutic apheresis services on the approved hospital order form and ensure the order, along with the signed informed consent, is present in the patient chart prior to the start of the procedure.
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Plasmapheresis
Plateletpheresis
Red Cell Exchange
Leukapheresis