Peace Island Outpatient Infusion Center

How to Refer a Patient

If you are not a PeaceHealth provider, the following elements are required before we can process your order and schedule your patient for treatment.

Please fax the following information to our office at 360-378-1799.  This information is necessary to write orders at our facility.

• Copy of active medical license
• Copy of DEA license
• Copy of Malpractice Insurance
• NPI number
• Recent progress note from the ordering provider
• Relevant lab results and other supporting documentation
• Insurance information with an authorization number for treatment ordered
• Complete and signed orders ( please use the PeaceHealth approved paper orders)

To send an order to the Infusion Center:

1. Locate the infusion order linked below
2. Click to open or download the PDF
3. Print the PDF and complete all fields
4. Fax the completed and signed infusion order to 360-378-1799