Subcutaneous immune globulin (SCIg) is a blood product alternative to IVIg, offering patients (and caregivers) who have received appropriate training an at home infusion option.

SCIg home infusion programs are managed and maintained by individual Health Authorities. The templates below are resources Health Authorities may wish to customize for their own programs or clinics. These documents are currently undergoing a review process and will be updated/modified in the near future.

 

 

SCIG Resource Kit

SCIG Resource Kit Cover Sheet

Under Review 

Provincial Guidelines for SCIG Home Infusion Programs

Under Review 
 Training Materials  

Teaching Plan

 Under Review

Patient Post-Training Quiz

 

Patient Skills Assessment

 

Patient Evaluation of Training

 

Pre-Training Letter to GP

Under Review 

Post-Training Letter to GP

 Under Review
Patient Handouts
 

Patient Brochure

 Under Review

Patient Handbook

 

Quick Reference Guide: How to draw SCIG into a syringe

Under Review 

Infusion Log

 
Form and Letter Templates
 

Patient Referral Form

Under Review 

Patient Consent and Participation Agreement 

 

Patient Intake Form 

 

SCIG Patient Enrolment Form - Gamunex 

 

SCIG Patient Enrolment Form - Hizentra

 

SCIG Product Order / Pick-up Form - Gamunex 

 

SCIG Product Order / Pick-up Form - Hizentra

 

Travel Letter - Gamunex

 

Travel Letter - Hizentra