Infusion Referrals

pdf icon Click to download infusion referral form

When referring a patient to this office, please include the following (used for utilization review and/or insurance verification purposes only):

-Insurance card copy (front and back)
-A copy of your internal demographic sheet
-Most recent H+P medical notes and infusion notes
-Relevant lab/diagnostic results (please include autoimmune panel)
-Recent medication list

Please fax all referring information to the following: (310) 855-9309

Once this office is in receipt of your request, we will begin the insurance verification process and attempt to get your patient on the infusion schedule within 5-7 days of the request.