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Home Care Medical Respiratory Care 5665 South Westridge Drive New Berlin, Wisconsin 53151 Ph 262.786.9870 x208 homecaremedical.com Prescription: Oxygen and Nebulizer Form STEP 1 PHYSICIAN AND PATIENT.

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Since oxygen is a drug, it must be prescribed on a drug chart (paper or electronic). Most drug charts have a section for oxygen prescribing. As with any drug, if oxygen can be stopped, then the prescription on the drug chart should be crossed off (or discontinued on electronic prescribing platforms).

Supplemental oxygen can be delivered in a variety of ways. The most common methods are tanks (or cylinders) of oxygen and oxygen concentrators. Both tanks and concentrators can be either stationary or portable. A tank of oxygen contains either compressed oxygen gas or, less frequently, liquid oxygen.

The prescription will state: Here is an example: 2 litres of oxygen per minute (LPM) or 24%. The duration of oxygen treatment. This is the number of hours you need to use your oxygen each day. If your doctor writes 'continuous oxygen therapy', this means that you must use oxygen at least 15 hours a day.

Home Oxygen Consent Form (HOCF): Must be completed. Consent by patient is not consent to treatment but the transfer of patient personal information to the supplier to support service delivery, as required by the Data Protection Act 1998 and is essential when patient first receives home oxygen service.

LTOT is indicated for patients with chronic obstructive pulmonary disease (COPD) when: A resting PaO2 = 7.3 kPa (55 mm Hg) or SaO2 88% or less while being at rest in a stable clinical condition.

Because it is a drug, oxygen orders must be obtained and should include the following information: The word “Oxygen” (obviously). Amount -- usually expressed as a liter flow or a percentage. Duration – such as “continuous” or “12 hours/day” or “PRN” (as needed). Delivery device/modality.

Home oxygen therapy is prescribed for some patients who have low oxygen in their blood and need more oxygen than is available from room air alone. Low blood oxygen may be due to a number of chronic, mainly respiratory, conditions. For example, Chronic Obstructive Pulmonary Disease (COPD).

Oxygen should be prescribed to achieve a target saturation of 94–98% for most acutely ill patients or 88–92% for those at risk of hypercapnic respiratory failure (tables 1–3).

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© Copyright 1997-2025
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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232