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Ordering Oxygen infographic

This information was approved by Jeff Swigris, DO, and Ann Mullen, RN, (September 2017)

Summary: Ordering Oxygen

What is Required from Providers?

Complete the following events within 30 days. 

Face-to-Face Evaluation

Progress Note Indicating:

  • Diagnosis

  • Symptoms

  • Mobility within and outside the home

  • Benefit of oxygen for quality of life

  • Flow rates and delivery type (pulse vs continuous)

  • Other methods have been tried and failed

  • Patient informed of need for oxygen


Qualifying Testing

Must have 1 of the following:

  1. Resting sat on room air ≤ 88% (while awake)


  1. Oxygen titration walk test (must have all 3 below)

    • Resting sat/ABG normal

    • Saturation ≤ 88% with exertion (or PO2 ≤ 55)

    • Exertion saturation/ABG improve with addition of O2


Dispensing Order

Order Indicating the Following:
  • Diagnosis

  • Duration

  • Flow Rates

  • Stationary Flow System

  • Standard Concentrator

  • Portable Flow System

    • Compressed Gas

    • Liquid Oxygen

    • Portable Oxygen Concentrator

  • Length of Need

  • Indication if oxygen will be used with PAP


Certificate of Medical Necessity


Additional Resources on Oxygen

Benefits of Oxygen Therapy

Oxygen Needs with IPF

Concerns about Wearing Oxygen

Altitude Sickness and Oxygen Therapy


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