Get New York Blood Center Physician Order Form

Filling out the New York Blood Center Physician Order Form online is essential for organizing and facilitating the process of autologous serum eye drop donations. This guide will lead you step-by-step in completing the form efficiently.

Follow the steps to complete the Physician Order Form online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering the patient information in the specified fields. Include the full name (last, first, middle initial), gender, birth date, and address. Ensure that all information is accurate.
3. Proceed to fill out the hospital information. Record the facility name and address, ensuring not to abbreviate any details.
4. In the ASED order information section, indicate the number of ASED 250ml collections required by filling in the appropriate field.
5. Complete the medical clearance section carefully. List any past or present medical conditions and medications relevant to the patient’s eligibility to donate.
6. Next, provide the ordering physician's information, including their name, phone number, and fax number. Ensure that the physician’s signature and date are included to validate the order.
7. Review all filled sections for completeness and accuracy. Verification is crucial, especially for donor eligibility and safety.
8. Once everything is filled out, you can save your changes. The completed form can be downloaded, printed, or shared as needed.
9. Finally, fax the signed order form to the provided number and ensure that the patient contacts the New York Blood Center’s special collections office to schedule their donation.

Start filling out your documents online today for a streamlined donation process.