Submit a Referral
Use the drug forms below to submit a referral for review by an Ascend Infusion referral coordinator. For each patient, we require:
- Demographic and insurance information
- Completed and signed order
- Necessary lab results as needed by drug protocol
- Office notes that support the medical necessity for infusion therapy
- Contact information for referring provider (provider name, practice name, address, phone, and fax)
- Please fax this over to 843.793.6181
Once approved, we will add the documentation and order to the patient’s EMR.
