Recommendations  Dated

IVIg Utilization Management Program Recommendations

Jul 2019

TMS IVIg Request Process Dated

IVIg Request Process 

Dec 2022
Provincial Screening Request Form
Dated

TMS IVIg Screening Request Form

For centralized screening of IVIg for all Adult Rheumatology conditions, and Neurology conditions as per the Neurology program guidelines

Sep 2023
Outcome Questionnaires  Dated

Peripheral Nervous System Conditions: IVIg Outcome Questionnaire

To be used for Non-Approved Peripheral Nervous System conditions only.

 

Sep 2023

Central Nervous System Conditions: IVIg Outcome Questionnaire

To be used for Central Nervous System conditions only.

 

Sep 2023

Rheumatology Conditions: IVIg Outcome Questionnaire

To be used for Adult Rheumatology conditions only.

Sep 2022
Order Form Templates
Dated

Secondary Immunodeficiency Ig NEW Request Template

To be used as a template for Health Authorities to create their specific SID Ig order form. 

Jul 2021

Secondary Immunodeficiency Ig RENEWAL Request Template

To be used as a template for Health Authorities to create their specific SID Ig order form. 

Oct 2023

Physician's Order for IVIg Template

To be used as a physician’s order form template for IVIg at the Health Authority. Conditions listed are approved for use of IVIg in BC.

Jul 2019 

Physician's Order for IVIg Template - Neurology 

To be used as an order form template for IVIg, for Health Authority Physicians.

 Jun 2022

TMS IVIG Request Process