| Infusion Referral

Patient Information | |

Name:
<PtFullName>

DOB:
<PtDoB>

Phone:
<PtPhoneMob>

Allergies:<Reactions>

Clinical Information | |

Weight: 
<Weight>

Hb (for iron infusion): 
<Hb>

Ferritin (for iron infusion): 
<Ferritin>

Pregnant: 
<Pregnant>

Gestation in weeks: 
<Gestation>

Infusion Order | Clinical Notes:
<Infusion order> | <Clinical Notes>
Referring Doctor |

Name:
<DrName>

Provider Number:
<DrProviderNo>

Address:
<DrAddress>

Signature:

Date:
<TodaysDate>

1.	Payment is required on the day of treatment. We accept credit cards such as Visa, Mastercard, and EFTPOS.
2.	It is advisable to bring a jacket or scarf in case you feel cold during the infusion.
3.	Please note that we do not have facilities to accommodate children.
4.	To ensure patient privacy, we kindly request that anyone accompanying you waits in the waiting room.
5.	For your comfort during the appointment, please wear loose-fitting clothing that allows your sleeve to be rolled up above the elbow. This will facilitate the insertion of the intravenous (IV) cannula and enable you to sit comfortably for the required duration.
6.	Please make sure you have eaten and are well-hydrated before your appointment. This will make the IV cannulation process easier and more comfortable.
7.	If you have a heart or kidney condition, please consult your doctor for appropriate guidance.
8.	Intravenous (IV) infusions involve the administration of fluids or medications directly into the bloodstream using an IV cannula. At GS Infusion Service, a registered nurse willbe responsible for inserting the IV cannula.
9.	To ensure a safe infusion, a large vein in the forearm is typically chosen. A tourniquet is applied, and a small plastic tube (cannula) is inserted into the vein through a needle. Once the cannula is in place, the needle is removed, leaving the soft cannula in the vein for medication or fluid administration. After removing the tourniquet, a dressing is applied to secure the cannula.
10.	Discomfort should be minimal and should subside shortly after the needle is removed from the cannula. The medication or IV fluid is then connected to the cannula for administration into the vein. After the infusion is complete, the cannula is removed, and pressure is applied to the site to stop any bleeding.
11.	Bruising and irritation at the cannula site may occur for several days following the infusion. Although infection is a rare risk associated with any medical procedure, it is important to monitor the IV site for redness or pain over the next 7 days. If either of these symptoms occurs, please consult your doctor for further assessment and appropriate treatment.

LOCATION AND PARKING
GS Infusion Service is located within Green Square Health, at 4/965 Bourke Street Waterloo on the ground floor of the Taylors House building.

Undercover parking is available in the building. Access is from Powell street, drive behind Taylors College and down into the driveway. Dial 2 on the intercom and our staff will let you in.

Alternatively there is street parking available on Bourke Street, Powell Street and Short Street.

We are a 7 minute walk from Green Square Station.

BOOKING AN INFUSION
Once you have your completed referral and collected your prescribed infusion from your pharmacy, you can book an appointment online at www.gshealth.com.au and click ‘book appointment’. 

Select your infusion type, and pick a time that suits you best. We’re also available on Saturdays.

Alternatively you can call us on 02 9699 8111 and speak to one of our friendly staff who can help you through the process.

Investigations Report: <Ix>

4/965 Bourke St
Waterloo 2017

T: 02 9699 8111 - F: 02 9698 9244
Healthlink ID: gshealth
gsinfusion.com.au