A home oxygen consent form (HOCF) should always be completed prior to completing a Home Oxygen Order Form (HOOF). The consent form allows you to share information with the local home oxygen provider.
For local arrangements to complete a HOOF you should always liaise with your local Home Oxygen Assessment Service or local Home Oxygen Supplier.
Only a Part A HOOF should be completed as a Part B HOOF is for specialist services.
Important: Initial Home Oxygen Risk Mitigation form (IHORM):This has been introduced to try and prevent any incidents occurring with oxygen in the home. The front of the form consists of questions the clinician needs to ask prior to oxygen being prescribed. The back of the form is the consent form. As of 1st August 2017, all healthcare professionals MUST complete an IHORM form in conjunction with the HOOF. A HOOF can not be submitted without the IHORM.
Completing the HOOF
It is essential that the HOOF, whether part A is completed as fully as possible. Certain items – marked by an asterix* – are compulsory and if not completed, will result in rejection of the form by the contractor (entailing delay and inconvenience for patients and HCP’s)
Sections 1 & 2
Patient & Carer details
1.7 – “Permanent address”; this should be the address where the supply installation is required. Please be careful if filling the form electronically from patient records, particularly if the supply is being made to a different location (i.e. not at the patients registered address)
Sections 3 & 4
Clinical Details & Patient’s GP Information
The clinical codes can be found on the bottom of Part A HOOF. The GP information is compulsory.
Sections 5 & 6
No sections here are marked as mandatory, however, we would strongly suggest that if the initiator of the HOOF is the assessment service or the ward, these should be regarded as mandatory, and completed in full.
Sections 7, 8 & 9
All parts are marked as mandatory; failure to complete in full will result in potential rejection and ensuing delay in the provision of supply.
Section 7 – the flow rate must be given as litres per minute. If a fractional component is required (e.g. 0.5, 1.5 LPM etc) please ensure the decimal point is clearly marked. There should also be a digit to the left of the decimal point (e.g. 0.5 rather than .5).
The period of use required to meet the patient’s need must be stated in hours per day, although periods of less than one hour can be expressed in minutes (e.g. 15 minutes or 15 min.).
Section 8 – The choice of equipment will ideally be based on a) the flow rate b) period of use c) expected length of treatment. As a guide but you should consult with your regional oxygen provider
• Ultra high flow rates (> 12 LPM) are generally provided via cylinder supply, particularly if period of use is short (e.g. 15 – 20 minutes per day)
• Lower flow rates and short periods of use (e.g. 1.5 LPM for 1hour per day) will generally best be provided via cylinder supply.
• Longer periods of use (e.g. above 4 hours per day) will generally best be provided via concentrator supply.
• Where the supply is likely to be in situ for a short period of time (e.g. a few days), with modest follow rate and period of use, again cylinder supply may be best.
The quantity to be ordered will depend on flow rate (concentrators) or flow rate & period of use (cylinders), please consult your home oxygen supplier.
You will need to decide the appropriate delivery mode, nasal cannula or mask. If selecting a mask, you will need to specify the % delivery (e.g. 28%) and type. Our local oxygen supplier will be able to give you information on what is available in your area
This is a mandatory section. You should mark one box only, selecting the most appropriate. Next (Calendar) Day is only for Home Oxygen Assesmsent Services and hospital discharges. We would strongly request that the urgent supply is reserved solely for truly urgent cases, this is within 4 hours.
Section 11 – also allows for specific requests, specific information to the contractor relating to supply (e.g. limited access etc) etc
Section 12 – Useful if a practice/department/service wishes oxygen related queries to be specifically directed.
This is all mandatory and self-explanatory. Please do not forget to mark whether the patient has, or is being, referred for formal assessment, or not.
Home oxygen suppliers
There are four companies in England that provide home oxygen services for the NHS and each covers a certain geographical area.
- Air Liquide: Call them on:
- 0808 143 9991 for London
- 0808 143 9992 for North West
- 0808 143 9993 for East Midlands
- 0808 143 9999 for South West
- Baywater Healthcare: covers Yorkshire and Humberside, West Midlands and Wales. Call them on 0800 373 580.
- BOC: covers the East and North East of England. Call them on 0800 136 603.
- Dolby Vivisol: covers the South Central and South East. Call them on 0500 823 773.