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.
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V
Therapy Information:
Name of Infusion Therapy (drug or enteral) Current Lab
Value is desirable.
-
TPN Patients:
- IV Antibiotic Patients, *Especially those on Vancomycin or Aminoglycosides (Amikacin, Gent, Tobra.)
- 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..
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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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