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Ordering home oxygen for children- a quick guide

****Please be aware that a new HOOF form was introduced in October 2009. The other forms are unchanged.****

Documents:

This page tells you all you need to know about prescribing oxygen. At the bottom of the page are links to pdf documents you will need to complete, including the home oxygen order forms. These forms can be downloaded and stored on your on computer to be printed off when needed. Alternatively you can print them directly from this site.

Here is a CHECKLIST to help the bemused clinician filling in and copying forms. It may be helpful to complete this as you copy all the forms, and file it with the retained copies.

Ordering home oxygen

  1. Print out a copy of each document (see below).
  2. Ask the parents to sign the Home Oxygen Consent Form which is obligatory before the oxygen company can be contacted with the patient details. This is kept in patient’s notes.
  3. Complete the 1 page Home Oxygen Order Form (HOOF) and fax it to your regional oxygen provider.
  4. Make 3 photocopies of the HOOF. Send a copy to your local PCT/LHB; to the patient’s GP; and to the Paediatric Clinical Lead for Home Oxygen for your Trust (the regional lead can give you the name of your local Trust lead). File the original HOOF in the patient’s records.

Paediatric Home Oxygen Record Form

  1. Complete the first section of the Paediatric Home Oxygen Record Form and file it in the child’s notes. When the child is reviewed please update the oxygen assessment section at appropriate times.
  2. If the child is using oxygen intermittently for palliation then please specify this in the “Additional information” section. This may make some other sections of the form irrelevant, but it would be helpful if some assessment of oxygen use is made.

Information sheets

Documents to be completed

  • Home Oxygen Order Form – HOOF (includes guidance sheet on completing form).
  • Home Oxygen Consent Form (to provide patient data to oxygen provider) – HOCF.
  • Paediatric Home Oxygen Record Form

    Additional helpful information

    Notes on Home Oxygen Parent Held record sheet
    There are sometimes problems with engineers working for the oxygen suppliers coping with the rapidly changing needs of our patients. This parent-held record is a suggested way of preventing any potential confusion. The sheet should be given to the parent(s), perhaps in a clear A4 document wallet, and every change in oxygen flow can be clearly documented. If instructions are given by phone, then the parents can complete the telephone instructions, and the health care professional can sign it off at the next visit. The form should be kept attached to the concentrator. Our sheets are printed on hospital headed notepaper, but feel free to adapt as needed.

    Request to remove home oxygen equipment
    This document is a standardised letter to request the oxygen supplier to remove equipment from one or more addresses. This may be because the patient no longer needs oxygen, or that they are no longer at the school, or visiting the relative specified in the secondary address. You could use this proforma to ask for removal from one primary and one secondary address. In the case of a child who has more than two sites for home ooxygen, you will need to complete a further form for each further secondary address. This is not an official form, just a useful proforma for you to adapt for your own use. It is suggested that you print it on your own hospital notepaper. It would probably be sensible to send a copy of the completed form to the GP and to the PCT/LHB.

    Rob Primhak 1 Sept 2006. Updated 12 Jun 2009