Dear Referring Healthcare Provider,
We are glad that you have chosen to refer your patient for continuation of allergy immunotherapy care to the Wheaton College Student Health Services (SHS). We take this responsibility seriously and want to make our requirements clear so that the student patient is taken care of in a quality manner in our office. This letter is simply to inform you of our practices within our primary care practice. If after reading this, you and the student patient would like to pursue SHS as an option to administer this specialized service, a more specific note of instructions will follow. Please review the following requirements:
- You and your practice will be the referring and ordering provider. Please provide SHS with NPI number and license number.
- You will provide exact orders regarding the allergen, dosing, scheduling, reaction protocol and discontinuation of this service.
- SHS will follow these orders exactly and will be allowed to call your office at any time if we have questions. We ask for professional courtesy as orders are clarified.
- SHS will not proceed in providing allergy immunotherapy to the student if they are not exactly clear on all parts of the process and we will be in contact with your office for clarification.
- Due to the fact that you and your office are the prescribing physician, it is policy that all orders from your office to SHS will be written, signed by the ordering provider (not CMA, RN) and faxed before SHS will proceed in administering any immunotherapy. Over the phone verbal orders are not satisfactory. SHS nursing staff can only legally take verbal orders from licensed professionals to staff at SHS.
- The chart and the vials must match and contain the following: 2 identifiers (DOB, MRN), patient’s full name, concentration, dosing, exact contents within each vial and expiration date. If you cannot comply with these requirements, then SHS can assist the student patient in finding an allergist’s office in this community.
- The student patient will be provided consent so that our offices can complete a continuation of care process. The student patient must also agree to terms of service. If the student patient accrues 2 no shows, we will discharge them from our care and provide them with community resources. We will inform your office of this decision.
- A physician or nurse practitioner will be present at SHS during the complete immunotherapy process.
- SHS reserves the right to refuse immunotherapy to student patients if the above protocols are not completed.
If at this time you believe that SHS can provide quality care for your student patient, we request that you please review the Collaborative Services Agreement, sign, print name, date and return.
Thank you for your cooperation. Please let our office know if you have further concerns
Beth Walsh, RN, MSN, CPNP
Director, Student Health Services
Wheaton College, IL