Referring a Patient for Treatment
To refer a patient to the Provis Infusion Clinic download and complete the patient Referral Form and return to us by fax.
Click the button to download, open and print the Provis Infusion Clinic patient referral form in adobe (.pdf) format. When you have completed the referral form please return it via fax: (416) 532-3635. Also, a Medication Order Form (MOF – listed below) will be needed to be completed and faxed to Provis, either with the original referral form or shortly before treatment is to be initiated.
The patient will be contacted directly to discuss insurance coverage and cost of treatment and start date.
Each cycle of therapy requires the completion of a new Medication Order as it is expected that patients will be reviewed regularly by their treating oncologist prior to each cycle of therapy.
Important: All medication orders are reviewed by a pharmacist and reviewed at the Provis Infusion Clinic by a staff physician prior to starting therapy. In all supporting documents forwarded to the insurer it is important to indicate that the treatment will be delivered in a private clinic outside of a public hospital. Most recent bloodwork will be needed to be faxed to Provis before each cycle or treatment depending on the medication.
No drug will be given at the Provis Infusion Clinic if it is available and funded in the public system in Ontario for the particular indication and the patient fulfills guideline criteria for public funding.
Current Drugs Available:
To download and print specific medication order form, click on the link next to the medication.
- Abraxane™ Order Form & Information
- Adcetris™ Order Form
- Alimta® Order Form
- Avastin® Order Form & Information
- Caelyx® Order Form & Information
- Cisplatin® Order Form
- Eloxatin® Order Form & Information
- Erbitux® Order Form & Information
- Gemzar™ Order Form & Information
- Havalen® Order Form
- Herceptin® Order Form & Information
- Jevtana® Order Form
- Kadcyla® Order Form & Information
- Keytruda® Order Form
- Kyprolis ® Order Form
- Opdivo® Order Form
- Perjeta ® Order Form & Information
- Rituxan® Order Form & Information
- Taxotere® Order Form
- Torisel® Order Form & Information
- Treanda® Order Form
- Vectibix® Order Form & Information
- Velcade® Order Form
- Velcade® Maintenance Order Form
- Venofer® Order Form
- Zometa® Order Form
Physician – Frequently Asked Questions
Q: What if a patient is also receiving medication(s) in the public healthcare system?
A: There may be circumstances where patients are also receiving other “funded” intravenous medication from their treating oncologist, in the public system. In such cases the treatments must be coordinated and scheduled appropriately between Provis and the hospital.
Q: What is your “turnaround” time for a new referral?
A: Although we would prefer a few days to process and contact a new referral, we can intake and treat a patient for a Tuesday infusion if we receive the new referral and MOF before 11am on the Monday prior to the Tuesday infusion day. In rare circumstances, we can process a new referral before 10:30 am on the day of the infusion, depending on the availability of the medication. At Provis we try and be as flexible as possible.
Q: Who is the “most responsible physician” (MRP)?
A: Provis Infusion Clinic Inc. will be responsible for all aspects of patient care during their time at our clinic. Acute treatment-related issues will be handled by the Provis medical staff with referral to local health facilities as deemed necessary. If complications from treatment arise after leaving the Provis Infusion Clinic patients will be instructed to go to the local emergency room or contact their oncologist depending on the urgency of the problem.
Q: What kind of medical record will document the treatment given?
A: A record of infusion is faxed to the referring physician after each treatment at Provis Infusion Clinic. The referring physician also receives a final treatment summary by fax upon completion of the treatment schedule or in case of termination of treatment.
Q: What happens if an “unfunded” drug becomes funded during the time that the patient is attending Provis Infusion Clinic?
A: In keeping with our formulary policy the patient will be informed of the availability of the drug in the public system and will be asked to consult their treating oncologist about continuing a therapy that has been started at Provis Infusion Clinic.
Q: What kind of medical supervision is provided at Provis Infusion Clinic?
A: A physician is present at all times during patient treatment sessions. Registered oncology nurses, specialized in chemotherapy infusion, administer medications. Our staff has an average of ten years in-hospital oncology nursing experience. Emergency procedures and 911 protocol are established.
Q: What happens if Provis Infusion Clinic declines to treat the patient for medical reasons?
A: If treatment is declined because of poor patient condition or abnormal laboratory results (preventing the administration of an agent), the attending oncologist who referred the patient will be contacted as to the reason for withholding treatment. A written record will accompany the patient on leaving the clinic to be taken to his/her attending oncologist. Provis Infusion Clinic Inc. reserves the right not to administer a treatment if felt medically inappropriate.
Q: Does this violate the Canada Health Act?
A: No. Outside of a public hospital patients may purchase medications and have them infused by a service provider.
Why Choose Provis?
- Infusion Services Since 2005
- Over 13,000+ Infusions To Date
- Most Comprehensive Oncology Drug Formulary in Canada
- Onsite Medication Compounding Facility
- Experienced Pharmacists On-Site
- Experienced Oncology Trained Nurses
- Supervising Physician On-Site
15 Year Anniversary!The Provis Infusion Clinic is please to announce that August 2020 marks the 15 anniversary of the Provis Infusion Clinic. We are looking forward to the next 15 years of providing high quality infusion services.
COVID 19 TrialProvis is pleased to partner with University Health Network, University of Toronto, EMS services and Police Services on a Phase 3 Clinical Trial focusing on COVUD 19. Called 'Cobra' the trial will look at the effectiveness of the vaccine BCG in the minimization of the COVID symptoms and the contraction of the virus.
New MedicationsVenofer™ (Iron Sucrose) Onivyde™ (Irinotecan liposome for injection) Tecentriq™ (Atezolizumab) Renflexis™ (Infliximab) Yondelis™ (Trabectedin) Yervoy™ (Ipilimumab)
Kyprolis™ (Carfilzomib) receives Health Canada approval.Health Canada has approved Kyprolis™ (carfilzomib) in combination with lenalidomide and dexamethasone for the treatment of patients with relapsed multiple myeloma who have received one to three prior lines of therapy.
Opdivo™ (Nivolumab) receives Health Canada approval.Opdivo™ is the first anti PD-1 (programmed death-1) approved to treat previously untreated cases of BRAF V600 wild-type unresectable or metastatic melanoma in adults. The approval was made under the Health Canada Priority Review process, after having met the criteria of substantial evidence of clinical effectiveness providing an improved benefit/risk profile over existing therapies. Provis is also able to provide Opdivo™ for other indications if required.
Keytruda™ (Pembrolizumab) now offered at ProvisAUTHORIZATION WITH CONDITIONS OF KEYTRUDA™ for the treatment of patients with unresectable or metastatic melanoma and disease progression following ipilimumab therapy and, if BRAF V600 mutation positive, following a BRAF or MEK inhibitor
Update – Patient Support Programs
Keytruda®, Perjeta®, Herceptin®, Avastin®,Jevtana®, Rituxan®, Abraxane® Kadcyla® Tecentriq® Yervoy® Opdivo® Patients: Provis participates in the Roche Patient Assistance Program, the , the OnCare Program, the Merck Care Oncology, and Celgene Abraxane® Access Program . These program offers financial assistance to qualified patients receiving Tecentriq®, Keytruda®, Perjeta®, Herceptin®, Avastin®, Rituxan®, Abraxane®,Opdivo® ® and Kadcyla® Read More >>
Non-Muscle Invasive Bladder CancerProvis works with the University Urology Associates (UUA), in providing the compounded MMC for electronically stimulated Mitomycin-C (EMDA MMC) to treat non-muscle invasive bladder cancer.