Download Form

To download therapy-specific drug order forms, contact us for delivery to your office.

Compile Documentation

Collect patient information, including demographics, insurance details, and relevant medical records.

Send to Us

Fax the signed order form with supporting documents to the patient’s preferred American Infusion Care location, or email to referrals@americaninfusioncare.com (include location and patient name in the subject line).

Order Forms

General Forms
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General Forms

AIC consent form Download Form
AIC Generic Blank Drug Order form Download Form
Allergy Immunology Download Form
Alpha1 Proteinase Download Form
Erythopoesis stimulating agent, procrit , retacrit, aranesp Download Form
Hemophilia_Clotting Disorder Download Form
Hepatitis B Download Form
Iron Download Form
IVIG Download Form
Nephrology Download Form
Patient Medication List Download Form

Medication Order Forms

D

Dalvance Download Form
Darzalex (daratumumab) Download Form

E

Elaprase Download Form
Elfabrio Download Form
Entyvio Download Form
Epogen Download Form
Evenity (romosozumab) Download Form
Evkeeza Download Form

F

Fabrazyme Download Form
Fasenra Download Form
Fereheme Download Form
Ferrlecit Download Form

G

Gammagard Liquid Download Form
Gammagard S-D Download Form
Gammunex Download Form
Givlaari (Givosiran) Download Form
Glassia Download Form

H

HyQvia Download Form

I

Ilaris Download Form
Illumya Download Form
Immune Globulin Download Form
Inflectra Download Form
Infliximab Download Form
Injectafer Download Form
Intralipid Download Form

J

Jubbonti Download Form

K

Kanuma Download Form
Keytruda Download Form
Kisunla Download Form
Krystexxa Download Form

L

Lemtrada Download Form
Leqembi Download Form
Leqvio Download Form
Loqtorzi Download Form
Lumizyme Download Form

N

Nexviazyme Download Form
Nucala Download Form
Nulojix Download Form

O

Ocrevus Zunovo Download Form
Ocrevus Download Form
Octagam Download Form
Omvoh Download Form
Onpattro Download Form
Opdivo Qvantig Download Form
Opdivo Download Form
Orencia Download Form
Oxulmo Download Form

P

Pemgarda Download Form
Privigen Download Form
Procrit Download Form
Prolastin-C Liquid Download Form
Prolia Download Form

Q

Qutenza Download Form

R

Radicava Download Form
Remicade Download Form
Renflexis Download Form
Retacrit Download Form
Riabni Download Form
Rituxan Download Form
Rituximab Download Form
Ruxience Download Form
Rystiggo Download Form

S

Saphnelo Download Form
Simponi Aria Download Form
Skyrizi Download Form
Soliris Download Form
Solu-Medrol Download Form
Somatuline (Lanreotide) Download Form
Spevigo Download Form
Stelara Download Form

T

Tepezza Download Form
Tezspire Download Form
Thyrogen Download Form
Tofidence Download Form
Tremfya Download Form
Truxima Download Form
Tyenne Download Form
Tysabri Download Form
Tzield Download Form

U

Ultomiris Download Form
Uplizna Download Form

V

Venofer Download Form
Vivitrol Download Form
VPRIV Download Form
Vyepti Download Form
Vyvgart Download Form
Vyvgart Hytrulo Download Form

X

Xolair Download Form

Y

Yeztugo Download Form

Z

Zoledronic Acid (Reclast) Download Form

Corporate

Pharmaceutical Manufacturers Specialty Pharmacy Hubs Specialty Pharmacies Self-Funded Employers Accountable Care Organizations (ACOs) Value Based Care/Integrated Networks Infusion Research Companies

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Order Forms

Medication Order Forms

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Corporate

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