Send An Infusion Order

A straightforward referral process for specialty infusion therapy.

Submit your referral order along with relevant clinical documentation, recent laboratory results, and insurance information. Upon receipt, our team reviews the referral, coordinates benefits verification and authorization requirements, and communicates with your office if additional information is needed.

Patients are contacted once the necessary clinical and administrative requirements have been completed and scheduling is appropriate.

Referral Forms

Select the appropriate referral form below and submit it by fax, email, or other approved submission channels.

Please include the following information when submitting a referral for Actemra or Tyenne:

  • Results of a recent tuberculosis (TB) skin/lab testing
  • Clinicals to support one or more of the following:
    • Patient has moderately to severely active rheumatoid arthritis (RA) who has had an inadequate response to one or more disease modifying anti-rheumatic drugs (DMARDs)
    • Patient has giant cell arteritis (GCA)
    • Patient has active polyarticular juvenile idiopathic arthritis
    • Patient has active systemic juvenile idiopathic arthritis

Referral forms

How To Submit An Infusion Order

Providers may submit orders by email, fax, or by direct phone contact with our referral desk.

Email

  • Download, complete, and save all forms above (Adobe Acrobat recommended)
  • Attach and email all signed forms to [email protected]

Fax

  • Print, complete, and sign all forms above.
  • Fax all signed forms to (505) 420-4848

Please include the following information when submitting a referral for Entyvio:
  • Results of a recent tuberculosis (TB) skin/lab testing
  • Patient’s current weight and height
  • Clinicals to support one or more of the following:
  • Patient has moderately to severely active Crohn’s disease (CD)
  • Patient has moderately to severely active ulcerative colitis (UC)

Referral forms

How To Submit An Infusion Order

Providers may submit orders by email, fax, or by direct phone contact with our referral desk.

Email

  • Download, complete, and save all forms above (Adobe Acrobat recommended)
  • Attach and email all signed forms to [email protected]

Fax

  • Print, complete, and sign all forms above.
  • Fax all signed forms to (505) 420-4848

Please include the following information when submitting a referral for Infliximab (Remicade, Inflectra, Renflexis, Avsola):
  • Result of Tuberculosis (TB) skin/ lab testing
  • Hepatitis B status & date
  • Patients current weight and height
  • Clinicals to support one or more of the following:
  • Patient has active moderate to severe Crohn’s disease (CD)
  • Patient has active moderately to severely active Ulcerative Colitis (UC)
  • Patient has Rheumatoid Arthritis (RA)
  • Patient has Psoriatic Arthritis
  • Patient has Ankylosing Spondylitis
  • Patient has Plaque Psoriasis
  Important Announcement Payors and health plans often require patients to use a specified infliximab product. All infliximab patient referrals will be reviewed by Optimum Infusion to determine the preferred infliximab product as required by the patient’s health plan.

Referral forms

How To Submit An Infusion Order

Providers may submit orders by email, fax, or by direct phone contact with our referral desk.

Email

  • Download, complete, and save all forms above (Adobe Acrobat recommended)
  • Attach and email all signed forms to [email protected]

Fax

  • Print, complete, and sign all forms above.
  • Fax all signed forms to (505) 420-4848

Please include the following information when submitting a referral for iron:
  • Most recent lab results
  • Patient has iron deficiency anemia, chronic kidney disease and is over 2 years of age

Referral forms

How To Submit An Infusion Order

Providers may submit orders by email, fax, or by direct phone contact with our referral desk.

Email

  • Download, complete, and save all forms above (Adobe Acrobat recommended)
  • Attach and email all signed forms to [email protected]

Fax

  • Print, complete, and sign all forms above.
  • Fax all signed forms to (505) 420-4848

Please include the following information when submitting a referral for Krystexxa:
  • Perform serum uric acid (sUA) test prior to each infusion
  • Screen patients at risk for G6PD deficiency prior to starting therapy
  • Patient had chronic gout and is an adult patient who have failed to normalize serum or has shown an inadequate response to conventional therapy

Referral forms

How To Submit An Infusion Order

Providers may submit orders by email, fax, or by direct phone contact with our referral desk.

Email

  • Download, complete, and save all forms above (Adobe Acrobat recommended)
  • Attach and email all signed forms to [email protected]

Fax

  • Print, complete, and sign all forms above.
  • Fax all signed forms to (505) 420-4848

Please include the following information when submitting a referral for Ocrevus:
  • Results of a Hepatitis B virus lab
  • Quantitative serum immunoglobulin results
  • Clinicals to support one or more of the following:
    • Patient has relapsing multiple sclerosis (RMS)
    • Patient has primary progressive multiple sclerosis (PPMS)
    • Patient has secondary progressive multiple sclerosis (SPMS)

Referral forms

How To Submit An Infusion Order

Providers may submit orders by email, fax, or by direct phone contact with our referral desk.

Email

  • Download, complete, and save all forms above (Adobe Acrobat recommended)
  • Attach and email all signed forms to [email protected]

Fax

  • Print, complete, and sign all forms above.
  • Fax all signed forms to (505) 420-4848

Please include the following information when submitting a referral for Orencia:
  • Patient’s current weight and height
  • Clinicals to support one or more of the following:
    • Patient has rheumatoid arthritis (RA)
    • Patient has juvenile idiopathic arthritis (JIA)
    • Patient has psoriatic arthritis

Referral forms

How To Submit An Infusion Order

Providers may submit orders by email, fax, or by direct phone contact with our referral desk.

Email

  • Download, complete, and save all forms above (Adobe Acrobat recommended)
  • Attach and email all signed forms to [email protected]

Fax

  • Print, complete, and sign all forms above.
  • Fax all signed forms to (505) 420-4848

Please include the following information when submitting a referral for Skyrizi:
  • Result of Tuberculosis (TB) skin/ lab testing
  • Baseline Liver Enzymes and Bilirubin

Referral forms

How To Submit An Infusion Order

Providers may submit orders by email, fax, or by direct phone contact with our referral desk.

Email

  • Download, complete, and save all forms above (Adobe Acrobat recommended)
  • Attach and email all signed forms to [email protected]

Fax

  • Print, complete, and sign all forms above.
  • Fax all signed forms to (505) 420-4848

Please submit the following to make a referral for Stelara:

Referral forms

How To Submit An Infusion Order

Providers may submit orders by email, fax, or by direct phone contact with our referral desk.

Email

  • Download, complete, and save all forms above (Adobe Acrobat recommended)
  • Attach and email all signed forms to [email protected]

Fax

  • Print, complete, and sign all forms above.
  • Fax all signed forms to (505) 420-4848

Please include the following information when submitting a referral for Tremfya:
  • Adult patients with moderately to severely active ulcerative colitis or moderately to severely active Crohn’s disease
  • Recent TB test results

Referral forms

How To Submit An Infusion Order

Providers may submit orders by email, fax, or by direct phone contact with our referral desk.

Email

  • Download, complete, and save all forms above (Adobe Acrobat recommended)
  • Attach and email all signed forms to [email protected]

Fax

  • Print, complete, and sign all forms above.
  • Fax all signed forms to (505) 420-4848

Please include the following information when submitting a referral for Natalizumab (Tysabri or Tyruko):
  • Clinicals to support one or more of the following:
  • Patient has relapsing-remitting multiple sclerosis (RRMS)
  • Patient has moderately to severely active Crohn’s disease (CD) who had an inadequate response to, or was unable to tolerate, conventional CD therapies and inhibitors of TNF
  • JCV results

Referral forms

How To Submit An Infusion Order

Providers may submit orders by email, fax, or by direct phone contact with our referral desk.

Email

  • Download, complete, and save all forms above (Adobe Acrobat recommended)
  • Attach and email all signed forms to [email protected]

Fax

  • Print, complete, and sign all forms above.
  • Fax all signed forms to (505) 420-4848