Outpatient Infusion Order Forms
Outpatient Infusion Locations
- Providence Portland Medical Center Outpatient Infusion
Epic Order Department: OPH OP INFUSION - Providence Willamette Falls Medical Center Outpatient Infusion
Epic Order Department: OWF OP INFUSION PLAZA 1 - Providence Newberg Medical Center Outpatient Infusion
Epic Order Department: OPH PCI Newberg Infusion - Providence Seaside Hospital Outpatient Infusion
Epic Order Department: OSS OP INFUSION - Providence Hood River Memorial Hospital Outpatient Infusion
Epic Order Department: OHR OP INFUSION - Providence Medford Medical Center Noel Lesley Infusion Center
Epic Order Department: OMD OP TRANSFUSION AND CHEMO
Please send your referral/order to the Epic department listed in the location page for the appropriate infusion center.
Important Information
Please fill out the MOBILITY CHECKLIST within the order, to help us keep your patients safe. Please call the clinic for significant mobility concerns or if the patient is not independent with self-care.
- Portland: 503-215-6046
- Willamette Falls: 503-215-6046
- Medford: 541-732-7000
- Hood River: 541-387-6445
- Seaside: 503-717-7650
- Newberg: 503-537-6040
Order Forms
Download and print the appropriate order form below. Please be sure to fill out all sections, sign the order, and fax to the appropriate site listed on the form.
- Abatacept (ORENCIA)
- Albumin Postparacentesis
- Agalsidase beta (FABRAZYME)
- Alteplase (ACTIVASE TPA) for HD Catheter
- Belimumab (BENLYSTA)
- Bezlotoxumab (ZINPLAVA)
- Blood Transfusion
- Ceftriaxone (ROCEPHIN)
- Cosyntropin (CORTROSYN)
- Cyclophosphamide (CYTOXAN)
- Dalbavancin (DALVANCE)
- Daptomycin (CUBICIN)
- Darbepoetin Alfa (ARANESP)
- Denosumab (PROLIA)
- Efgartigimodalfa-fcab (VYVGART)
- Epoetin Alfa (RETACRIT & Biosimilars)
- Eptinezumab-jjmr (VYEPTI)
- Ertapenem (INVANZ)
- Ferric Carboxymaltose (INJECTAFER)
- Ferric Derisomaltose (MONOFERRIC)
- Ferric Gluconate (FERRLECIT)
- Ferumoxytol (FERAHEME)
- Filgrastim (NIVESTYM & Biosimilars)
- Golimumab (SIMPONI ARIA)
- Hydration & Electrolytes
- Ibandronate (BONIVA)
- Immune Globulin (IVIG)
- Infliximab (REMICADE & Biosimilars)
- Iron Dextran (INFED)
- Iron Sucrose (VENOFER)
- Levoloxacin (LEVAQUIN)
- Mepolizumab (NUCALA)
- Methotrexate for Ectopic Pregnancy
- Methylprednisolone (SOLUMEDROL)
- Natalizumab (TYSABRI)
- Ocrelizumab (OCREVUS)
- Omalizumab (XOLAIR)
- Outpatient OSTOMY Clinic
- PARQ for OB Iron
- Pembrolizumab (KEYTRUDA) Onc
- PICC & Midline Placement
- PICC & Port Maintenance
- Risankizumabrzaa (SKYRIZI)
- Rituximab (RITUXAN & Biosimilars)
- Therapeutic Phlebotomy
- Ublituximabxiiy (BRIUMVI) Infusion
- Ustekinumab (STELARA)
- Vancomycin (VANCOCIN)
- Vedolizumab (ENTYVIO)
- Zoledronic Acid (RECLAST)
- Zoledronic Acid (ZOMETA)
- Other & Miscellaneous