For administration of a once-a-month injection given to your baby to protect him or her during RSV season. (RSV Season is generally November 1 to March 31) This shot is not part of the normal immunizations, but is an antibody against RSV.
General Criteria Requirements
Chronic Lung Disease
Premature Births (<35 weeks & 0 days)
Congenital Heart Diseases
Severe combined or advanced acquired immunodeficiency <24 months of age
Congenital Abnormalities of the Airway (<12 mos. of age)
Neuromuscular Disorders (<12 mos. of age)
Approved criteria requirements must meet medical necessity
Gestational birth age and present age are crucial for criteria selection
Dosages are administered once monthly up to 5 doses with exceptions during the RSV season.
Referrals are processed promptly with confirmation notification sent to referring practitioner & primary care physician.
Patient’s insurance benefits and prior authorizations are obtained by clinic coordinator, reviewed and scheduled with parent before administering injections.
Clinic contact number is 937-641-5618 or fax at 937-641-3229
Please fill out referral form and send in for processing as directed.
Clinics are offered conveniently at the hospital or as approved through Children’s Home Care of Dayton.
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