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HOOF Guidelines

This box needs to be ticked. If the patient is unable to provide consent then a family member or carer can provide it in their place.

Please ensure that patient consent is obtained when completing a HOOF.

Complete all patient details.

This is required on all HOOF orders, including existing patients.

Include the full permanent home address and and postcode for the patient on the HOOF.

Carers details are required if the patient will not be at their address to take the delivery for an installation.

Carers details are required for all hospital discharges.

If the patient requires a delivery to a second address please include the following information:

- Full address including the postcode
- Contact name & telephone number
- Dates from and to

Clinical codes can be found on the reverse of the HOOF.

If the patient is under 18 tick ‘yes’ to the paediatric order

NIV: Non invasive ventilation
CPAP: Continuous positive airway pressure

Please provide any details you think maybe useful to us in the ‘important details’ section, for example if the patient is frail or has any language needs

The patient’s GP practise is required on all HOOF orders Please include full address, postcode and contact numbers, we do need the fax number to use to confirm any orders.

Include details of the PCT/LHB the GP’s practise lies within.

The HOOF must include full details of the main clinical contact. This person will be contacted with any queries regarding the HOOF order.

Complete in case of a hospital discharge order. The full hospital address including the postcode is required.

Please give contact details of the ward if the patient is still in hospital.

Sections 5/6/7 of the HOOF need to be fully completed as required.

The litres per minute as prescribed must be included in all modes of supply required by the patient. Hours per day need to be completed to provide an estimation of maximum usage by the patient per day. Ambulatory oxygen can only be supplied for a maximum of 16 hours per day.

In all situations it is required that either a nasal cannulae or mask is indicated to show which the patient will be using.

Please use the table below for matching litres per minute with the appropriate masks.

Mask Percentage	Barrel colour	Flow rate
24 %	Blue	2 litres/minute
28 %	White	2 & 4 litres/minute
31 %	Orange	6 litres/minute
35 %	Yellow	8 litres/minute
40 %	Red	10 litres/minute
60 %	Green	15 litres/minute
100 %	N/a	8 - 15 litres/minute

Nasal cannulae can be supplied on any of the flow rates and exclusively on 1,3,5 and 7 litres per minute High flow cannulae can be supplied above 8 litres per minute. This is only advisable for patients using oxygen for short periods of time due to the potential damage to the nasal passage.

We are able to supply cannulae and masks on 2 litres per minute only. In this case a 28% mask will provide a guaranteed 28% concentration while the cannulae will provide an approximate 28% concentration.

If the patient requires both nasal cannulae and mask in any other circumstances please provide a reason in section 1.21 on the HOOF If the healthcare professional is supplying the patient with masks or cannulae and non are required from Air Products please state this clearly in section 1.21 on the HOOF.

The type of delivery must be indicated here Urgent response will be delivered within 4 hours.

Next day will be delivered the following day – for clinical assessments and hospital discharges only

Standard delivery is within 3 working days

This section of the HOOF needs to be fully completed with the details of the health care professional prescribing oxygen for the patient. Please sign and date the HOOF and clearly print the healthcare professionals name and position.

If there are any further questions regarding completing a HOOF please contact Air Products on:

0800 373 580.

Once completed submit the HOOF to Air Products on fax number:

0800 214 709.

Be aware that if the Home Oxygen Order Form (HOOF) is completed with missing information the form will not be processed until the information is supplied?