Once you have completed the Enteral Nutrition Form, please fax it to your Apria representative at (your assigned fax number). You can also email the form to the provided email address for electronic submission. Ensure to keep a copy for your records and provide any additional information that may be required for processing.

Ensure you are aware of the updates in regulations or policy changes in 2024 and 2025 affecting enteral nutrition orders.

The purpose of this form is to facilitate the accurate ordering of enteral nutrition supplies for patients requiring such care. By capturing detailed patient information and specific dietary requirements, healthcare providers can ensure their patients receive the appropriate supplies and nutrition. This process streamlines communication between healthcare professionals and suppliers, improving patient outcomes.

• 1. Patient Information: Includes personal details such as name, date of birth, and contact information.
• 2. Insurance Information: Captures insurance provider and ID details for billing purposes.
• 3. Enteral Order: Specifies the nutritional requirements including formula names and volumes.
• 4. Feeding Schedule: Documents the method and timing for enteral feeding.
• 5. Signatures: Requires the prescriber's name and signature for authorization.

Failure to submit this form may delay the necessary enteral nutrition supplies for the patient. It's crucial to complete all sections accurately to avoid any disruptions in care.

• Delayed Nutrition Supply: Without timely submission, patients may experience interruptions in their nutritional regimen.
• Inaccurate Orders: Incorrectly filled forms may lead to improper supplies being sent.
• Insurance Issues: Incomplete forms can complicate insurance claims and approvals.
• Communication Breakdown: Failure to submit can lead to misunderstandings between healthcare providers and suppliers.
• Patient Health Risks: Delays or inaccuracies in supplies can adversely affect a patient's health.

• 1. Pre-Discharge Planning: Essential for preparing home care supplies prior to patient discharge from hospital.
• 2. Routine Supply Orders: To reorder nutrition supplies for ongoing patient needs.
• 3. Insurance Documentation: Utilized for providing necessary paperwork for insurance claims.
• 4. Emergency Situations: To quickly arrange supplies when a patient’s needs change unexpectedly.
• 5. Special Dietary Needs: For patients requiring specific formulas or modified diets.