36C26119Q0692-004.docx
DOCX document 15 KB Posted
- Attached to
- VACCHCS Pharmaceutical Compounding Services Multiple-Award Blanket Purchase Agreement (BPA) Federal contract opportunity
- Solicitation number
- 36C26119Q0692
About this file
36C26119Q0692 Attachment #1 VACCHCS Hazardous Drug Compounding Form.docx
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Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| 36C26119Q0692-002.docx | DOCX document | |
| 36C26119Q0692-003.docx | DOCX document |
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Text version
VACCHCS Hazardous Drug Compounding Form
· Fax form no later than 11AM, contact Community Home Infusion via phone call within 15 minutes to confirm receipt of fax. Repeat until transmission of all documents successful.
· For cases with special circumstances or requests, fill out form and contact Community Home Infusion
· Form will be filled out daily. If no order is needed, fill out form and specify “no order needed for ##/##/#### (date) under the instructions filed and fax.
| Date:______________ | VAMC Fresno | |
| Patient Name | ||
| Last four of SSN | ||
| Special Timing | ||
| Instructions |
| Zzscan, A |
| 0000 |
| Ex: Please deliver Monday morning by 10AM, please prepare by 10AM for VA pick up, etc. |
| Ex. Use CADD cassette, prime line with saline, use non absorbing line, use set with 0.2 micron filter, etc |
Ex. Fluorouracil 5200mg Continuous Infusion over two days. Use 104 ml of 5-FU, 10 ml of heparin 1,000 unit/ml and 136 ml NS in CADD for total volume of 250ml. Stability 7 days at room temp. Protect from light.
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