Refer a patient for infusion therapy

To begin the referral process, choose a medication or therapy from the order form list below.

View order forms
How to refer a patient

How to refer a patient for infusion therapy

Referring a patient for infusion therapy services at Ascension sites of care is simple. Just complete the form — our team will take it from there. Follow these easy steps:

  1. Find the medication or therapy: Choose the appropriate medication or therapy from the order forms below. Download and print the form before completing it.
  2. Complete and submit the form: Complete the printed order form and include any required clinical documentation. Fax the completed materials to the number listed below for the Ascension market where your patient will receive care.
  3. We contact your patient and schedule the infusion: Our team will review the order, verify insurance coverage and handle any prior authorization. From there, we’ll contact your patient directly to review financial responsibility and schedule treatment.
  4. We contact your office once treatment is complete: Once treatment is complete, your office receives confirmation and any treatment notes.

For general questions, email PharmacyCentralizedIntake@ascension.org.

Infusion referral phone and fax numbers

Use the contact information below to submit your completed referral form to the Ascension market or location where your patient will receive infusion therapy.

Ascension markets with centralized referral numbers

Market
Phone
Fax
Florida – Jacksonville 904-296-5994 904-296-9070
Florida – Pensacola 850-416-6705 850-416-6010
Illinois – Chicago (Saint Joseph Chicago) 773-665-8007 773-665-8008
Illinois – Elk Grove Village (Alexian Brothers Medical Center) 847-981-3505 847-956-5443
Illinois – Hoffman Estates (St. Alexius Medical Center, Hoffman Estates) 847-839-6460 847-839-6464
Maryland – Baltimore 667-234-5463 667-234-4048
Oklahoma – Tulsa 918-744-2070 918-932-3328
Tennessee – Nashville 615-222-3389 314-649-2755
Texas – Austin 512-324-7865 512-324-7972
Texas – Austin: Adult Gastroenterology, Dermatology and Rheumatology 317-207-0215 512-969-2650
Texas – Austin: OB / IV iron 512-324-5660 512-969-2650
Wisconsin – Appleton 920-738-2030 920-831-1381
Wisconsin – Glendale 414-527-5000 414-527-5005
Wisconsin – Milwaukee 414-326-1800 414-326-1801
Wisconsin – Racine 262-687-2600 262-687-2626

Markets with location-specific referral numbers

For markets without centralized referral numbers, select a market or area below to find the phone and fax number for the location where your patient will receive treatment.

  • Indiana – Evansville area
    Location Phone Fax
    Ascension St. Vincent Evansville Infusion Center – Evansville 812-485-7775 812-485-7920
    Ascension St. Vincent Evansville Cancer Center – Newburgh 812-471-1200 812-475-6700
    Ascension St. Vincent Warrick Infusion – Boonville 812-897-4800 812-897-7376
  • Indiana – Indianapolis and surrounding areas
    Location Phone Fax
    Ascension St. Vincent Anderson Cardiology – Anderson 765-646-8612 765-646-8602
    Ascension St. Vincent Anderson Chemotherapy & Infusion – Anderson 765-683-3209 765-683-3253
    Ascension St. Vincent Carmel Infusion – Carmel 317-582-7902 317-582-8009
    Ascension St. Vincent Outpatient Treatment Center – Carmel 317-582-8278 317-582-8269
    Ascension St. Vincent Mercy Infusion – Elwood 765-552-4585 765-552-4720
    Ascension St. Vincent Fishers Infusion – Fishers 317-415-9549 317-231-5509
    Ascension St. Vincent Cancer Care & Infusion – Indianapolis 317-338-5671 317-338-5688
    Ascension St. Vincent Infusion & Procedure Center – Indianapolis 317-338-3230 317-338-3350
    Peyton Manning Children's – Pediatric Digestive Care – Indianapolis 317-338-9450 317-338-9567
    Peyton Manning Children's – Pediatric Cancer Care & Hematology – Indianapolis 317-338-4673 317-338-3227
    Ascension St. Vincent Indianapolis Hematology Oncology – Indianapolis 317-338-4985 317-338-4952
    PMCH Surgery and Procedure Center – Indianapolis 317-338-9487 317-338-3685
    Ascension St. Vincent Kokomo Ambulatory Infusion – Kokomo 765-236-8185 765-456-5816
    Ascension St. Vincent Kokomo Cancer Center – Kokomo 765-456-5687 765-456-5811
    Ascension St. Vincent Randolph Infusion – Winchester 765-584-0587 765-584-0541
  • Kansas
    Location Phone Fax
    Ascension Via Christi St. Francis Ambulatory Infusion Center – Wichita 316-777-8367 316-291-7596
    Ascension Via Christi Ambulatory Infusion Center on Clifton – Wichita 316-274-1516 316-719-1010
    Ascension Medical Group Via Christi on Murdock – Wichita 316-274-8142 316-274-8158
    Ascension Via Christi St. Teresa Ambulatory Infusion Center – Wichita 316-796-7520 316-796-7529
    Pediatric Specialty Gastroenterology – Wichita 316-268-8040 316-291-7993
    Ascension Via Christi Home Medical Infusion Pharmacy – Wichita 316-858-2100 316-858-2170
    Manhattan Express Unit – Manhattan 785-587-4208 785-414-5829
    Wamego Health Center – Wamego 785-236-8413 316-779-2290
  • Texas – Waco
    Location Fax
    Ascension Providence Hospital – Waco 512-960-2303
    Providence Urology Group – Waco 512-960-2303

For general questions, email PharmacyCentralizedIntake@ascension.org


What your patients can expect

Ascension care teams work as an extension of your care team to help your patients receive ordered infusion therapy.

  • Prompt scheduling: Our centralized team coordinates scheduling directly with the infusion center, minimizing coordination for your office.
  • Efficient visits: Therapy duration is kept as short as clinically appropriate — typically 30 to 60 minutes, depending on the medication. When lab draws are required, total visit time also includes the time needed to receive and review results before treatment can proceed.
  • Clinically aligned therapy: Our pharmacy-led team ensures patients receive the most appropriate IV infusion therapy, balancing your clinical intent with insurance formulary requirements, site-of-care mandates and patient-specific considerations, including cost, number of treatments and access barriers (like transportation).

Infusion order forms

Choose a specialty below to find the medication or therapy you need. Download and print the appropriate order form before completing it.

Need help with a referral?

Contact our intake team at PharmacyCentralizedIntake@ascension.org if you need help choosing a form, confirming where to submit a referral or identifying the correct Ascension market or location.