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Information Needed for an Admission
Preferred Excellent Care Pharmacy
Pharmacy    PEC Healthcare · Home Health · Palliative Care Program    Hospice
10521 Garden Grove Blvd.
Garden Grove, CA 92843
Phone: (714) 590-3620 or
(877) 590-3620
Fax: (714) 590-3628 or
(877) 590-3628
E-mail: pecliaison@preferredexcellentcare.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.

V 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.

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