Home Photo Order 8_8_24.docx.pdf

Home Phototherapy Order

Phone Number 205-654-5339

Fax Number 833-471-6091

referrals@enlighteninfanthomecare.com

Current Date*

First and Last Name of Parent*

Mother's Date of Birth*

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Infant Name*

Infant's Date Of Birth*

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Sex*

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Infant Weight*

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Total/Direct Bilirubin Level

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Home Phototherapy Prescription

AEnlighten Infant Home Care (EIHC) will provide home phototherapy for continuous use.

Enlighten Infant Home Care (EIHC) will provide home phototherapy for continuous use using the Little Sparrows. bili-hut ™ or other device depending on equipment availability. EIHC RNs will provide parents with instruction on the use of the equipment.

*A daily nursing assessment with weight, vital signs and a STAT Neonatal Bilirubin T/D via heel stick will be performed daily while the baby is under our care and part of this service. Length of home care services will be evaluated daily by MD based on results.

Diagnosis

ANeonatal Jaundice, unspecified (P59.9)

BABO Isoimmunization of the Newborn (P55.1)

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