Therapeutic Phlebotomy Order Form
Therapeutic Phlebotomy is a treatment that involves removing blood from a patient who may have a blood disorder, such as iron overload, hemochromatosis, Polycythemia, Hepatitis, Porphyria Cutanea Tarda, Sickle Cell Disease, and nonalcoholic fatty liver disease, that can be managed by drawing and removing blood.
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A phlebotomist or doctor will conduct a blood draw in an outpatient procedure to remove red blood cells and may replace them with a blood product or intravenous fluids. Barring any complications, this may alleviate symptoms for the patient. The Therapeutic Phlebotomy Order Form app should be completed by a doctor requesting a phlebotomist perform this procedure. The app will require documentation of blood tests and laboratory results, a diagnosis of the disease that needs to be treated, hemoglobin levels and any other specific instructions needed to safely perform the procedure.
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