Palmetto Infusion Plans of Treatment

To refer a patient, please choose the appropriate plan of treatment from the list below and fax to 1‐866‐872‐8920, or call 1‐800‐809‐1265 for assistance. Providers can also submit a plan of treatment electronically using the “Upload POTs/Referral Docs” button below.

• Actemra Pediatric Rheumatology Plan of Treatment
• Actemra Plan of Treatment Adult Giant Cell Arteritis
• Actemra Plan of Treatment Adult Rheumatology
• Adakveo Plan of Treatment
• Albumin Standard Plan of Treatment
• Alpha 1-Antitrypsin Deficiency Standard Plan of Treatment
• Amvuttra Plan of Treatment
• Antibiotics (Anti-infective) Standard Plan of Treatment
• Antiemetic Standard Plan of Treatment
• Aredia (pamidronate disodium) Standard Plan of Treatment
• Avsola Dermatology Plan of Treatment
• Avsola Gastroenterology Plan of Treatment
• Avsola Rheumatology Plan of Treatment
• Avsola Standard Plan of Treatment
• Benlysta Standard Plan of Treatment
• Boniva (ibandronate sodium) Standard Plan of Treatment
• Cabenuva Standard Plan of Treatment
• Cerezyme POT ICD 10 102215
• Cimzia Plan of Treatment for Gastroenterology
• Cimzia Plan of Treatment for Rheumatology
• Cinqair Plan of Treatment
• Crysvita Plan of Treatment for Adult Patients
• Crysvita Plan of Treatment for Pediatric Patients
• Cytoxan (Cyclophosphamide) Plan of Treatment (Not available in all locations)
• Dalvance Plan of Treatment
• Detail Written Order
• Elaprase POT ICD 10 102215
• Entyvio Gastroenterology Plan of Treatment
• Evenity Standard Plan of Treatment
• Evkeeza Standard Plan of Treatment
• Fabrazyme Standard Plan of Treatment
• Fasenra Standard Plan of Treatment
• Generic or Blank Plan of Treatment
• Givlaari Plan of Treatment
• Hydration Standard Plan of Treatment
• HyQvia Standard Plan of Treatment
• Ilumya Plan of Treatment
• Immunoglobulin Subcutaneous Standard Plan of Treatment
• Immunogobulin (IVIG) Plan of Treatment
• Inflectra Dermatology Plan of Treatment
• Inflectra Gastroenterology Plan of Treatment
• Inflectra Rheumatology Plan of Treatment
• Inflectra Standard Plan of Treatment
• Intralipids
• Iron Standard Plan of Treatment
• Kimyrsa Standard Plan of Treatment
• Krystexxa Standard Plan of Treatment
• Krystexxa Monitoring Protocol and Pre-infusion Medications
• Lemtrada Plan of Treatment (Not available in all locations)
• Leqvio Plan of Treatment
• Levothyroxine Standard Plan of Treatment
• Line Care Alteplase (Cathflo Activase) Standard Plan of Treatment
• Line Care for Dialysis or Hemapheresis Catheter Plan of Treatment
• Line Care Standard Plan of Treatment
• Lumizyme POT ICD 10 102215
• Magnesium Standard Plan of Treatment
• Nexviazyme Standard Plan of Treatment
• Nucala Plan of Treatment for EGPA
• Nucala Standard Plan of Treatment
• Nucala Standard Plan of Treatment for Nasal Polyps
• Nulojix Standard Plan of Treatment
• Ocrevus Plan of Treatment
• Onpattro Plan of Treatment
• Orbactiv Standard Plan of Treatment
• Orencia Adult Rheumatology Plan of Treatment
• Orencia Pediatric Rheumatology Plan of Treatment
• Physician Verbal Order DWO
• Prolia Standard Plan of Treatment
• Radicava Plan of Treatment
• Reclast (zoledronic acid) Standard Plan of Treatment
• Remicade Dermatology Plan of Treatment
• Remicade Gastroenterology Plan of Treatment
• Remicade Rheumatology Plan of Treatment
• Remicade Standard Plan of Treatment
• Renflexis Plan of Treatment for Dermatology
• Renflexis Plan of Treatment Gastroenterology
• Renflexis Plan of Treatment for Rheumatology
• Renflexis Standard Plan of Treatment
• Riabni Plan of Treatment for GPA or MPA
• Riabni Plan of Treatment for Rheumatology
• Rituxan Plan of Treatment for GPA or MPA
• Rituxan Plan of Treatment for Rheumatology
• Ruxience Standard Plan of Treatment for GPA or MPA
• Ruxience Plan of Treatment for Rheumatology
• Saphnelo Standard Plan of Treatment
• Simponi ARIA Standard Plan of Treatment
• Skyrizi Plan of Treatment for Gastroenterology
• Soliris Plan of Treatment for aHUS
• Soliris Plan of Treatment for aHUS for Pediatric Patients
• Soliris Plan of Treatment for Myasthenia Gravis
• Soliris Plan of Treamtent for NMOSD
• Soliris Plan of Treatment for PNH
• Solumedrol (Methylprednisolone) Plan of Treatment
• Standing Adverse Reaction Orders
• Stelara Plan of Treatment for Rheumatology
• Stelara Plan of Treatment for Gastroenterology
• Tepezza Plan of Treatment
• Tezspire Plan of Treatment
• TPN Plan of Treatment
• Trogarzo Plan of Treatment
• Truxima Plan of Treatment for GPA or MPA
• Truxima Plan of Treatment for Rheumatology
• Tysabri Plan of Treatment for Crohn’s Disease
• Tysabri Standard Plan of Treatment
• Tysabri Plan of Treatment for Multiple Sclerosis
• Ultomiris Plan of Treatment
• Uplizna Plan of Treatment
• Vimizim Plan of Treatment
• Vpriv Plan of Treatment
• Vyepti Plan of Treatment
• Vyvgart Plan of Treatment
• Xolair Standard Plan of Treatment for Asthma
• Xolair Standard Plan of Treatment for Nasal Polyps
• Xolair Standard Plan of Treatment for Urticaria
• Xgeva Plan of Treatment
• Zemdri Plan of Treatment