Infusion Services Orders
The VCU Health Tappahannock Hospital Infusion Center provides infusion services to patients across the Tappahannock and Northern Neck communities. We are located at 618 Hospital Rd. Tappahannock, VA. 22560. Our hours of operation are Monday through Friday, 8:00 a.m. to 4:30 p.m.
Printable, faxable order and consent forms are available below.
Follow these important steps to get started:
- Print and fill out the infusion order completely
- Ordering provider signature along with NPI is required.
- A phone number that we can reach the provider in case of an emergency is required.
- Fax completed forms along with patient’s insurance information and demographics to the VCU Health Tappahannock Hospital Infusion Center at (804) 443-6128.
Medication Order Forms:
- VCU Health Tappahannock Hospital General Infusion Services Referral Form
- VCU Health Tappahannock Hospital Infusion Services Referral Form_Retacrit
- VCU Health Tappahannock Hospital Infusion Services Referral Form_Reclast
- VCU Health Tappahannock Hospital Infusion Services Referral Form_Prolia
Blood Product Order and Consent Forms:
- VCU Health Tappahannock Hospital Blood Transfusion Consent
- VCU Health Tappahannock Hospital Outpatient Non-VCU Provider Blood Product Orders
Contact Us
Please call (804) 443-6137 with any questions. Please note: Patients will not be scheduled until insurance authorization has been obtained.
Please note: We do not offer same day blood transfusions. If considered urgent, please refer patient to the emergency room to be evaluated.