Recommendations | Dated |
July 2019 |
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TMS IVIG Request Process | Dated |
Jan 2017 | |
Forms & Templates |
Dated |
TMS IVIG Screening Request Form For TMS use when a Physician's Order for IVIG Form is received for a patient whose condition is not on the List of Approved Medical Conditions for IVIG use as outlined in the IVIG Utilization Management Program Guidelines, or who is a rheumatology patient over 18 years of age. |
Oct 2020 |
Physician's Order for IVIG Template To be used as a template for Health Authority Physician IVIG Order Forms. Conditions listed are approved for use of IVIG in BC. |
July 2019 |
IVIG Outcome Questionnaire Template To be used for all conditions, excluding Rheumatology and Non-Approved Neuromuscular. |
Jan 2017 |
IVIG Outcome Questionnaire for Adult Non-Approved NEUROMUSCULAR Conditions This template is to be used for Adult Non-Approved Neuromuscular conditions only. |
Jan 2017 |
IVIG Outcome Questionnaire for Adult RHEUMATOLOGY Conditions This template is to be used for Adult Rheumatology conditions only. |
June 2018 |
IVIG Dosing Information for Ordering Physicians Template Can be used as a communication tool to explain IVIG Dosing based on Adjusted Body Weight Calculation to ordering Physicians. |
Jan 2017 |
IVIG Hemolysis Letter Template Can be used as a communication tool to explain the risk of hemolysis in high dose IVIG therapy in group A, B, and AB patients. |
Jan 2017 |
TMS IVIG Request Process