Refer a Patient to PeaceHealth Cancer Infusion Center

To our referring healthcare providers

We are happy to care for your patient! If you have questions, please call 360-514-2005.

Refer to PeaceHealth St. John (Longview) Cancer Infusion Center
If you are not a PeaceHealth Medical Group provider, the following elements are required before we can process your order and schedule your patient for treatment.

Please FAX the following information, with the St. John Infusion Center Intake Form, to the intake coordinator at FAX number 360-501-0146.

 

  • Recent progress note from the ordering provider
  • Relevant laboratory results and/or other supporting documentation
  • Insurance documentation with the authorization number or reference number
  • A valid order (Please use the PeaceHealth-approved paper order)

 Remember to include the following information when filling out a paper order:

  • Patient name AND date of birth
  • Date of order issuance
  • ICD-10 code
  • Check the boxes of ALL orders you would like to activate
  • Provider signature at the bottom of each page of orders
  • Provider name (printed) and physical address of practice site
  • Name and contact information of the Provider that will be following this patient (if different than ordering provider)
  • For blood products, PeaceHealth Blood Transfusion Consent Form signed by Provider and Patient
  • Completed PeaceHealth St. John Infusion Center Intake Form – with special attention to the “Message to Providers”
Refer to PeaceHealth Southwest (Vancouver) Cancer Infusion Center
If you are not a PeaceHealth Medical Group provider, the following elements are required before we can process your order and schedule your patient for treatment.

Please FAX the following information to the intake coordinator at FAX number 360-514-1920
  • Recent progress note from the ordering provider
  • Relevant laboratory results and/or other supporting documentation
  • Insurance documentation with the authorization number or reference number
  • A valid order (Please use the PeaceHealth-approved paper order)

 Remember to include the following information when filling out a paper order:

  • Patient name AND date of birth
  • Date of order issuance
  • ICD-10 code
  • Check the boxes of ALL orders you would like to activate
  • Provider signature at the bottom of each page of orders
  • Provider name (printed) and physical address of practice site
  • Name and contact information of the Provider that will be following this patient (if different than ordering provider)
  • For blood products, PeaceHealth Blood Transfusion Consent Form signed by Provider and Patient
  • Completed PeaceHealth  Infusion Center Intake Form – with special attention to the “Message to Providers”