Referring a Patient for IDPN or IPN Therapy

To refer a patient, simply complete a referral form and fax to 866.403.4044. Or, you may call us directly at 800.626.4427 to make your referral.

Be sure to have the following information on the patient and their medical condition:

• Patient demographics
• Insurance information (Medicare/Medicaid numbers, private insurance)
• Medical history
• Albumin levels (last 3 months)
• Estimated oral intake (calories and protein)
• Hemo or Peritoneal dialysis regimen

This information is intended to facilitate the prompt assessment of a patient's eligibility to receive coverage for IDPN/IPN.

For additional questions, please contact us directly at 800.626.4427 to speak with an intake specialist or one of our dietitians.