Get Aspira Drainage System Discharge Prescription Form Urgent Physician Order 2019-2025

Filling out the Aspira Drainage System Discharge Prescription Form is an essential task for ensuring the proper discharge of patients requiring drainage care. This guide provides step-by-step instructions on how to accurately complete the form online to facilitate a smooth process.

Follow the steps to complete the Aspira Drainage System discharge prescription form online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Enter the patient's name, including their first and last name, and provide their phone number in the designated fields.
3. Include the discharge planner's contact information and patient's date of birth, ensuring the correct month, day, and year are selected.
4. Select the appropriate discharge option from the list provided, specifying if the patient will be discharged to home, hospice, skilled nursing facility, or hospital, along with any necessary agency names.
5. Indicate the quantity of Aspira drainage system supplies to send home with the patient by selecting one of the options available.
6. Specify the quantity of catheters placed, choosing either one or two, noting that bilateral catheter placements require proper medical documentation.
7. Choose the primary diagnosis related to the fluid's location from the given options, ensuring proper ICD codes are listed where applicable.
8. Select the secondary diagnosis that necessitates the catheter placement and drainage, using the provided options and space for additional diagnoses.
9. Fill out the drainage prescription by selecting the desired frequency for the Aspira drainage kit, ensuring choices are clear and exclude 'PRN' or 'as needed' options.
10. Complete the dressing prescription section similarly, selecting the frequency for the Aspira dressing kit as per the available choices.
11. Define the length of need or refills required, choosing from the timeline options outlined in the form.
12. Fill in the order date, and complete the physician attestation section by adding the physician's name, phone number, signature, NPI number, and date.
13. Finally, provide the facility or hospital name and contact information. Ensure all sections are filled in accurately before submitting.
14. Save the changes to the form, and choose to download, print, or share it as required for submission.

Complete the Aspira Drainage System Discharge Prescription Form online today for efficient patient care.