IV IRON INFUSION REFERRAL FORM

CLINICAL INFORMATION

Please tick any that may apply

Pregnant
Fluid Restriction
Heart Failure
Renal Failure

IRON ORDER

TYPE OF IRON given in divided doses: Max 1g per infusion *

Ferinject 0.5g(x1 vial)

Ferinject 1g (X2 vials)

Ferinject 1.5g (x3 vials)

Ferinject 2g (x4 vials)

OR *

Monofer 0.5g(x1 vial)

Monofer 1g(X2 vials)

Monofer 1.5g(x3 vials)

Monofer 2g(x4 vials)

DOSE CALCULATOR

  Weight <70kg Weight <70kg
Hb<100g/L 1.5g  
Hb<100g/L 1g 1.5g

Please ensure patient has been issued a valid script, our clinic does not keep iron on site, patient will require to have script filed prior to appointment

  Weight <70kg Weight <70kg
Hb<100g/L
 1.5g  
Hb<100g/L 1g 1.5g

REFERRING DOCTOR

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What are IV Drips?

When you consume a vitamin orally, whether it be over the counter or prescription, not everything is absorbed. What is absorbed by the stomach is taken directly to the liver where it may be metabolised. This results in only a fraction of what you consumed orally remaining into the bloodstream to be utilised as fuel and nourishes your body.

On the other hand, through IV Drips, 100% of the vitamins are delivered into your bloodstream bypassing the metabolism process. This results in the ability to get more vitamins, minerals, antioxidants, and amino acids to support your body to function at its best.