- For Providers
- Plans of Treatment
Palmetto Infusion
plans of treatment.
To refer a patient, please choose the appropriate plan of treatment from the list below and fax to 866‐872‐8920, or call 800‐809‐1265 for assistance. Providers can also submit a plan of treatment electronically using the “Upload POTs/Referral Docs” button below.
-
Referral Checklist
In addition to a signed and dated Plan of Treatment, please provide the following information to expedite the referral process:
- Diagnosis / ICD-10 diagnosis code
- Most recent history and physical including:
- Current / complete medication list
- Most recent office visit notes
- Past medical history
- Tried and failed therapies
- Allergy history
- Current height / weight
- Drugs and dosing schedule, including last dose and next dose due if applicable
- Most recent lab/test results clinically relevant to therapy. For example: Hep B panel, Calcium and CrCl, PPD Test, etc.
- Insurance information
- Upload POTs/Referral Docs
Find a Plan of Treatment
a
- Actemra Plan of Treatment for Adult Rheumatology
- Actemra Plan of Treatment for Adult Rheumatology
- Actemra Plan of Treatment for Adult Rheumatology
- Actemra Plan of Treatment for Pediatric Rheumatology
- Actemra Plan of Treatment for Pediatric Rheumatology
- Actemra Plan of Treatment for Pediatric Rheumatology
- Adakveo Plan of Treatment
- Adakveo Plan of Treatment
- Adakveo Plan of Treatment
- Albumin Plan of Treatment
- Albumin Plan of Treatment
- Albumin Plan of Treatment
- Aldurazyme Plan of Treatment
- Aldurazyme Plan of Treatment
- Aldurazyme Plan of Treatment
- Alpha-1-Antitrypsin Deficiency Plan of Treatment
- Alpha-1-Antitrypsin Deficiency Plan of Treatment
- Alpha-1-Antitrypsin Deficiency Plan of Treatment
- Amvuttra Plan of Treatment
- Amvuttra Plan of Treatment
- Amvuttra Plan of Treatment
- Home Infusion Anti-infective (Antibiotics, Antivirals, and Antifungals) Plan of Treatment
- Antibiotics (Anti-infective) Plan of Treatment
- Antibiotics (Anti-infective) Plan of Treatment
- Antibiotics (Anti-infective) Plan of Treatment
- Aralast Plan of Treatment
- Aralast Plan of Treatment
- Aralast Plan of Treatment
- Avsola Plan of Treatment for Dermatology
- Avsola Plan of Treatment for Dermatology
- Avsola Plan of Treatment for Dermatology
- Avsola Plan of Treatment for Gasteroenterology
- Avsola Plan of Treatment for Gastroenterology
- Avsola Plan of Treatment for Gastroenterology
- Avsola Plan of Treatment for Rheumatology
- Avsola Plan of Treatment for Rheumatology
- Avsola Plan of Treatment for Rheumatology
b
c
- Cabenuva Plan of Treatment
- Cabenuva Plan of Treatment
- Cabenuva Plan of Treatment
- Home Infusion Cathflo Plan of Treatment
- Cerezyme Plan of Treatment
- Cerezyme Plan of Treatment
- Cerezyme Plan of Treatment
- Cimzia Plan of Treatment for Gastroenterology
- Cimzia Plan of Treatment for Gastroenterology
- Cimzia Plan of Treatment for Gastroenterology
- Cimzia Plan of Treatment for Rheumatology
- Cimzia Plan of Treatment for Rheumatology
- Cimzia Plan of Treatment for Rheumatology
- Cinqair Plan of Treatment
- Cinqair Plan of Treatment
- Cinqair Plan of Treatment
- Cosentyx Plan of Treatment
- Cosentyx Plan of Treatment
- Cosentyx Plan of Treatment
- Crysvita Plan of Treatment for Adult Patients
- Crysvita Plan of Treatment for Adult Patients
- Crysvita Plan of Treatment for Adult Patients
- Crysvita Plan of Treatment for Pediatric Patients
- Crysvita Plan of Treatment for Pediatric Patients
- Crysvita Plan of Treatment for Pediatric Patients
e
- Elaprase Plan of Treatment
- Elaprase Plan of Treatment
- Elaprase Plan of Treatment
- Entyvio Plan of Treatment
- Entyvio Plan of Treatment
- Entyvio Plan of Treatment
- Evenity Plan of Treatment
- Evenity Plan of Treatment
- Evenity Plan of Treatment
- Evkeeza Plan of Treatment
- Evkeeza Plan of Treatment
- Evkeeza Plan of Treatment
f
- Fabrazyme Plan of Treatment
- Fabrazyme Plan of Treatment
- Fabrazyme Plan of Treatment
- Fasenra Plan of Treatment for Adult Patients
- Fasenra Plan of Treatment for Adult Patients
- Fasenra Plan of Treatment for Adult Patients
- Fasenra Plan of Treatment for Pediatric Patients
- Fasenra Plan of Treatment for Pediatric Patients
- Fasenra Plan of Treatment for Pediatric Patients
g
h
- Home Infusion Home Infusion Standing Order
- Hydration Plan of Treatment
- Hydration Plan of Treatment
- Hydration Plan of Treatment
- HyQvia Plan of Treatment
- HyQvia Plan of Treatment
- HyQvia Plan of Treatment
- HyQvia Plan of Treatment for CIDP
- HyQvia Plan of Treatment for CIDP
- HyQvia Plan of Treatment for CIDP
i
- Ilumya Plan of Treatment
- Ilumya Plan of Treatment
- Ilumya Plan of Treatment
- Immunoglobulin (IVIG) Plan of Treatment
- Immunoglobulin (IVIG) Plan of Treatment
- Immunoglobulin (IVIG) Plan of Treatment
- Home Infusion Immunoglobulin (IVIG) Plan of Treatment
- Immunoglobulin Subcutaneous Plan of Treatment
- Inflectra Plan of Treatment for Dermatology
- Inflectra Plan of Treatment for Dermatology
- Inflectra Plan of Treatment for Dermatology
- Inflectra Plan of Treatment for Gastroenterology
- Inflectra Plan of Treatment for Gastroenterology
- Inflectra Plan of Treatment for Gastroenterology
- Inflectra Plan of Treatment for Rheumatology
- Inflectra Plan of Treatment for Rheumatology
- Inflectra Plan of Treatment for Rheumatology
- Home Infusion Infliximab Plan of Treatment for Dermatology
- Infliximab Plan of Treatment for Dermatology
- Infliximab Plan of Treatment for Gastroenterology
- Home Infusion Infliximab Plan of Treatment for Gastroenterology
- Home Infusion Infliximab Plan of Treatment for Rheumatology
- Infliximab Plan of Treatment for Rheumatology
- Intralipids Plan of Treatment
- Intralipids Plan of Treatment
- Intralipids Plan of Treatment
- Iron Plan of Treatment
- Iron Plan of Treatment
- Iron Plan of Treatment
k
l
- Lemtrada Plan of Treatment (Not available in all locations)
- Lemtrada Plan of Treatment (Not available in all locations)
- Lemtrada Plan of Treatment (Not available in all locations)
- Leqvio Plan of Treatment
- Leqvio Plan of Treatment
- Leqvio Plan of Treatment
- Levothyroxine Plan of Treatment
- Levothyroxine Plan of Treatment
- Levothyroxine Plan of Treatment
- Line Care Alteplase (Cathflo Activase) Plan of Treatment
- Line Care Alteplase (Cathflo Activase) Plan of Treatment
- Line Care Alteplase (Cathflo Activase) Plan of Treatment
- Line Care Plan of Treatment
- Line Care Plan of Treatment
- Line Care Plan of Treatment
- Home Infusion Line Care Plan of Treatment
- Lumizyme Plan of Treatment
- Lumizyme Plan of Treatment
- Lumizyme Plan of Treatment
n
- Nexviazyme Plan of Treatment
- Nexviazyme Plan of Treatment
- Nexviazyme Plan of Treatment
- Nucala Plan of Treatment for Asthma
- Nucala Plan of Treatment for Asthma
- Nucala Plan of Treatment for Asthma
- Nucala Plan of Treatment for EGPA
- Nucala Plan of Treatment for EGPA
- Nucala Plan of Treatment for EGPA
- Nucala Plan of Treatment for Hypereosinophilic Syndrome (HES)
- Nucala Plan of Treatment for Hypereosinophilic Syndrome (HES)
- Nucala Plan of Treatment for Hypereosinophilic Syndrome (HES)
- Nucala Plan of Treatment for Nasal Polyps
- Nucala Plan of Treatment for Nasal Polyps
- Nucala Plan of Treatment for Nasal Polyps
- Nucala Plan of Treatment for Pediatric Asthma
- Nucala Plan of Treatment for Pediatric Asthma
- Nucala Plan of Treatment for Pediatric Asthma
- Nulojix Plan of Treatment
- Nulojix Plan of Treatment
- Nulojix Plan of Treatment
o
- Ocrevus Plan of Treatment
- Ocrevus Plan of Treatment
- Ocrevus Plan of Treatment
- Omvoh Plan of Treatment
- Omvoh Plan of Treatment
- Omvoh Plan of Treatment
- Onpattro Plan of Treatment
- Onpattro Plan of Treatment
- Onpattro Plan of Treatment
- Opdivo Plan of Treatment
- Opdivo Plan of Treatment
- Opdivo Plan of Treatment
- Orbactiv Plan of Treatment
- Orbactiv Plan of Treatment
- Orbactiv Plan of Treatment
- Orencia Plan of Treatment for Adult Rheumatology
- Orencia Plan of Treatment for Adult Rheumatology
- Orencia Plan of Treatment for Adult Rheumatology
- Orencia Plan of Treatment for Pediatric Rheumatology
- Orencia Plan of Treatment for Pediatric Rheumatology
- Orencia Plan of Treatment for Pediatric Rheumatology
p
r
- Radicava Plan of Treatment
- Radicava Plan of Treatment
- Radicava Plan of Treatment
- Reclast (zoledronic acid) Plan of Treatment
- Reclast (zoledronic acid) Plan of Treatment
- Reclast (zoledronic acid) Plan of Treatment
- Remicade Plan of Treatment for Dermatology
- Remicade Plan of Treatment for Dermatology
- Remicade Plan of Treatment for Dermatology
- Remicade Plan of Treatment for Gastroenterology
- Remicade Plan of Treatment for Gastroenterology
- Remicade Plan of Treatment for Gastroenterology
- Remicade Plan of Treatment for Rheumatology
- Remicade Plan of Treatment for Rheumatology
- Remicade Plan of Treatment for Rheumatology
- Renflexis Plan of Treatment for Dermatology
- Renflexis Plan of Treatment for Dermatology
- Renflexis Plan of Treatment for Dermatology
- Renflexis Plan of Treatment for Gastroenterology
- Renflexis Plan of Treatment for Gastroenterology
- Renflexis Plan of Treatment for Gastroenterology
- Renflexis Plan of Treatment for Rheumatology
- Renflexis Plan of Treatment for Rheumatology
- Renflexis Plan of Treatment for Rheumatology
- Riabni Plan of Treatment for GPA-MPA
- Riabni Plan of Treatment for GPA-MPA
- Riabni Plan of Treatment for GPA-MPA
- Riabni Plan of Treatment for Rheumatology
- Riabni Plan of Treatment for Rheumatology
- Riabni Plan of Treatment for Rheumatology
- Rituxan Plan of Treatment for GPA-MPA
- Rituxan Plan of Treatment for GPA-MPA
- Rituxan Plan of Treatment for GPA-MPA
- Rituxan Plan of Treatment for Rheumatology
- Rituxan Plan of Treatment for Rheumatology
- Rituxan Plan of Treatment for Rheumatology
- Ruxience Plan of Treatment for GPA-MPA
- Ruxience Plan of Treatment for GPA-MPA
- Ruxience Plan of Treatment for GPA-MPA
- Ruxience Plan of Treatment for Rheumatology
- Ruxience Plan of Treatment for Rheumatology
- Ruxience Plan of Treatment for Rheumatology
- Rystiggo Plan of Treatment
- Rystiggo Plan of Treatment
- Rystiggo Plan of Treatment
s
- Saphnelo Plan of Treatment
- Saphnelo Plan of Treatment
- Saphnelo Plan of Treatment
- Simponi ARIA Plan of Treatment
- Simponi ARIA Plan of Treatment
- Simponi ARIA Plan of Treatment
- Simponi ARIA Plan of Treatment for Pediatric Patients
- Simponi ARIA Plan of Treatment for Pediatric Patients
- Simponi ARIA Plan of Treatment for Pediatric Patients
- Skyrizi Plan of Treatment for Crohn’s
- Skyrizi Plan of Treatment for Crohn’s
- Skyrizi Plan of Treatment for Crohn’s
- Skyrizi Plan of Treatment for Ulcerative Colitis (UC)
- Skyrizi Plan of Treatment for Ulcerative Colitis (UC)
- Skyrizi Plan of Treatment for Ulcerative Colitis (UC)
- Soliris Plan of Treatment for aHUS
- Soliris Plan of Treatment for aHUS
- Soliris Plan of Treatment for aHUS
- Soliris Plan of Treatment for aHUS for Pediatric Patients
- Soliris Plan of Treatment for aHUS for Pediatric Patients
- Soliris Plan of Treatment for aHUS for Pediatric Patients
- Soliris Plan of Treatment for Myasthenia Gravis
- Soliris Plan of Treatment for Myasthenia Gravis
- Soliris Plan of Treatment for Myasthenia Gravis
- Soliris Plan of Treatment for NMOSD
- Soliris Plan of Treatment for NMOSD
- Soliris Plan of Treatment for NMOSD
- Soliris Plan of Treatment for PNH
- Soliris Plan of Treatment for PNH
- Soliris Plan of Treatment for PNH
- Solumedrol (Methylprednisolone) Plan of Treatment
- Solumedrol (Methylprednisolone) Plan of Treatment
- Solumedrol (Methylprednisolone) Plan of Treatment
- Home Infusion Solumedrol Plan of Treatment
- Spevigo Plan of Treatment
- Spevigo Plan of Treatment
- Spevigo Plan of Treatment
- Standing Adverse Reaction Orders
- Stelara Plan of Treatment for Gastroenterology
- Stelara Plan of Treatment for Gastroenterology
- Stelara Plan of Treatment for Gastroenterology
- Stelara Plan of Treatment for Rheumatology and Dermatology
- Stelara Plan of Treatment for Rheumatology and Dermatology
- Stelara Plan of Treatment for Rheumatology and Dermatology
t
- Tepezza Plan of Treatment
- Tepezza Plan of Treatment
- Tepezza Plan of Treatment
- Tezspire Plan of Treatment
- Tezspire Plan of Treatment
- Tezspire Plan of Treatment
- Tocilizumab Plan of Treatment for Pediatric Rheumatology
- Tocilizumab Plan of Treatment for Pediatric Rheumatology
- Tocilizumab Plan of Treatment for Pediatric Rheumatology
- Tocilizumab Plan of Treatment for Rheumatology
- Tocilizumab Plan of Treatment for Rheumatology
- Tocilizumab Plan of Treatment for Rheumatology
- Tremfya Plan of Treatment for UC
- Tremfya Plan of Treatment for UC
- Tremfya Plan of Treatment for UC
- Trogarzo Plan of Treatment
- Trogarzo Plan of Treatment
- Trogarzo Plan of Treatment
- Truxima Plan of Treatment for GPA-MPA
- Truxima Plan of Treatment for GPA-MPA
- Truxima Plan of Treatment for GPA-MPA
- Truxima Plan of Treatment for Rheumatology
- Truxima Plan of Treatment for Rheumatology
- Truxima Plan of Treatment for Rheumatology
- Tyenne Plan of Treatment for Pediatric Rheumatology
- Tyenne Plan of Treatment for Pediatric Rheumatology
- Tyenne Plan of Treatment for Pediatric Rheumatology
- Tyenne Plan of Treatment for Rheumatology
- Tyenne Plan of Treatment for Rheumatology
- Tyenne Plan of Treatment for Rheumatology
- Tysabri Plan of Treatment
- Tysabri Plan of Treatment
- Tysabri Plan of Treatment
- Tzield Plan of Treatment
- Tzield Plan of Treatment
- Tzield Plan of Treatment
u
v
- Vimizim Plan of Treatment
- Vimizim Plan of Treatment
- Vimizim Plan of Treatment
- Vpriv Plan of Treatment
- Vpriv Plan of Treatment
- Vpriv Plan of Treatment
- Vyepti Plan of Treatment
- Vyepti Plan of Treatment
- Vyepti Plan of Treatment
- Vyvgart Hytrulo Plan of Treatment
- Vyvgart Hytrulo Plan of Treatment
- Vyvgart Hytrulo Plan of Treatment
- Vyvgart Hytrulo Plan of Treatment for CIDP
- Vyvgart Hytrulo Plan of Treatment for CIDP
- Vyvgart Hytrulo Plan of Treatment for CIDP
- Vyvgart Plan of Treatment
- Vyvgart Plan of Treatment
- Vyvgart Plan of Treatment
x
- Xgeva Plan of Treatment
- Xgeva Plan of Treatment
- Xgeva Plan of Treatment
- Xolair IgE- Plan of Treatment for Medicated Food Allergies
- Xolair IgE- Plan of Treatment for Medicated Food Allergies
- Xolair IgE- Plan of Treatment for Medicated Food Allergies
- Xolair Plan of Treatment for Asthma
- Xolair Plan of Treatment for Asthma
- Xolair Plan of Treatment for Asthma
- Xolair Plan of Treatment for Nasal Polyps
- Xolair Plan of Treatment for Nasal Polyps
- Xolair Plan of Treatment for Nasal Polyps
- Xolair Plan of Treatment for Urticaria
- Xolair Plan of Treatment for Urticaria
- Xolair Plan of Treatment for Urticaria