Tandem Diabetes Care Insulin Pump Start Orders
This file contains essential instructions and details for initiating insulin pump therapy for diabetes care. Healthcare providers can complete this form to set parameters for the patient's insulin therapy. It includes personal profile settings, calculator for transitioning to pump therapy, and additional settings.
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How do I fill this out?
Filling out this form is simple and straightforward. Start by providing the patient's information, including their name and date of birth. Then, follow the instructions to complete the sections regarding insulin training details and personal profile settings.
How to fill out the Tandem Diabetes Care Insulin Pump Start Orders?
1
Provide patient information including name and date of birth.
2
Complete sections 1, 2, and 3 as instructed.
3
Specify the insulin type and training details.
4
Fill out the personal profile settings as required.
5
Sign and date the form to verify accuracy.
Who needs the Tandem Diabetes Care Insulin Pump Start Orders?
1
Diabetes educators who need to set up patients on insulin pumps.
2
Endocrinologists who require a structured approach for initiating pump therapy.
3
Patients transitioning from multiple daily injections to pump therapy.
4
Healthcare providers managing insulin-dependent patients.
5
Clinical coordinators overseeing pump therapy programs.
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What are the instructions for submitting this form?
To submit this form, ensure all sections are completed accurately. You can fax your submission to 855-877-6784 or email it to the provided healthcare provider's email address. For physical submissions, please send to the address listed in the form's footer.
What are the important dates for this form in 2024 and 2025?
For 2024, submissions must be made by March 1 for quarterly reviews. In 2025, ensure all forms are completed by January 15 to avoid therapy delays.
What is the purpose of this form?
The primary purpose of this form is to facilitate the proper initiation of insulin pump therapy for patients with diabetes. It provides a structured method for healthcare providers to document essential patient information and therapy parameters. This ensures that all relevant factors are considered for effective diabetes management.
Tell me about this form and its components and fields line-by-line.
- 1. Patient's Name: Enter the full name of the patient.
- 2. Date of Birth: Input the patient's date of birth.
- 3. Healthcare Provider: Document the name of the healthcare provider.
- 4. Insulin Start: Specify the type of insulin to be used.
- 5. Personal Profile Settings: Input individual settings for the patient.
- 6. Additional Instructions: Provide any extra guidance needed for therapy.
What happens if I fail to submit this form?
Failing to submit this form can result in delays in treatment for the patient. Without timely initiation of pump therapy, patients may experience difficulties in managing their diabetes effectively.
- Patient Safety: Inaccurate or missing information can jeopardize patient safety.
- Therapy Delays: Incomplete submissions may lead to postponed treatment plans.
- Regulatory Compliance: Failure to follow submission protocols could result in compliance issues.
How do I know when to use this form?
- 1. Transitioning Patients: Use this form for patients moving from MDI to pump therapy.
- 2. New Insulin Pump Users: Initiate therapy for patients who are starting on an insulin pump.
- 3. Regular Therapy Reviews: Utilize for routine reviews of pump settings and adjustments.
Frequently Asked Questions
What information is needed to fill out this form?
You'll need to provide patient details, insulin information, and personal profile settings.
Can I edit the PDF after downloading?
You can edit the PDF on PrintFriendly before downloading it.
What if I make a mistake in the calculations?
Review your entries carefully before finalizing the form.
Is there a specific insulin type required?
Yes, the form specifies U-100 analog insulin for use with Tandem pumps.
How do I ensure accuracy in my entries?
Follow the guidelines provided in the form and double-check your calculations.
Do I need a prescription for saline?
Yes, a prescription is required for saline use with the pump.
What happens if I submit an incomplete form?
An incomplete form may lead to delays in therapy initiation.
Is there a maximum bolus instruction?
Yes, there's a default maximum bolus setting of 10 units.
Can I share this PDF with my healthcare provider?
Yes, sharing options are available to send the PDF to your HCP.
What should I do if I have questions while filling out the form?
Consult your healthcare provider or refer to the instructions on the form.
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