Waiting Is Not A Treatment Plan
Our Promise Is 48 Hours, Not Weeks
Our infusion team is trusted by referring providers across New Mexico for complex, high-acuity regimens, backed by more than 100 years of combined clinical experience.
Partner With Us in Your Patient’s Care
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.
- 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.
- 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 (must be dated within 6 months)
- Hepatitis B status & date (must be dated within 6 months)
- CBC lab results (must be dated within 6 months)
- CMP lab results (must be dated within 6 months)
- 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.
- 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.
- 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.
- 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.
- 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
Referral forms
How To Submit An Infusion Order
Providers may submit orders by email, fax, or by direct phone contact with our referral desk.
- 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.
- 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.
- 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
- List of current medications and surgical procedures used to treat condition
- Patient’s current weight and height
- T3/T4 Lab
- Clinicals to support patient has Thyroid Eye Disease (TED)
Referral forms
How To Submit An Infusion Order
Providers may submit orders by email, fax, or by direct phone contact with our referral desk.
- 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
- 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.
- 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.
- 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