Step by step guide to completing a Home Oxygen Order Form (HOOF)

Ordering form 1

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

If the patient is aged below 18 please tick ‘YES’ to paediatric order.

Consent needs to be ticked ‘YES’. If the patient is unable to provide consent a family member or carer can provide it in their place.

Ordering form 2

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

Tick ‘NO’ to permanent address if the patient is using the address temporarily. Also please enter their permanent address on the HOOF, box 13.

Carers details are required if the patient will not be at their address to take the delivery for an installation. Carer’s details are required for hospital discharge orders.

Ordering form

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

Ordering form

In the case of a hospital discharge order, the full hospital address including the postcode is required on the HOOF.

Ordering form

The patients GP practice is required on all HOOF orders. Please include full address and postcode.

Ordering form

GP contact details required including the PCT the practice is within.

If the patient requires a delivery to a holiday address please include the following information in box 13 of the HOOF-

Full holiday address including postcode.
Holiday dates (From – To)
Contact name and telephone number.

Booking name and reference where appropriate.

Ordering form

Sections 7, 8 and 9 of the HOOF need to be fully completed as required.
The litres/minute as prescribed must be included in all modes of supply required by the patient.
Hours/day need to be completed to provide an estimate of maximum usage by the patient per day. Ambulatory oxygen can only be supplied for a maximum of 16 hours/day.

In sections 7 and 9 it is required that either a nasal cannulae or mask is indicated to show which the patient will be using. Please see the table below for matching litres/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 above flow rates and exclusively on 1, 3, 5 and 7 litres/minute
High flow cannulae can be supplied above 8 litres/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/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 cannulae and mask in any other circumstances, please provide a reason in Box 13 on the HOOF.

If the patient requires humidification this is supplied for long term oxygen (Box 7) and must be indicated on the HOOF to be supplied.

Ordering form

Please tick this box if the patient requires delivery within 4 hours.

Alternatively, delivery will be within 3 working days unless a next day hospital discharge order has been requested.

Ordering form

Hospital discharge orders are supplied as either ‘next day’ or ‘3 working day’ orders. If a next day order is required please tick ‘YES’ to next day delivery. If ‘NO’ is ticked a 3 day delivery will be supplied.
The ward telephone number is required for any HOOF queries. If there is no direct ward number please supply the hospital number and ward extension or ward name/ number.
For hospital discharge orders please make sure the carers details are completed in section 2 of the form. This carer will need to be available to take delivery on the required day between 8.30am and 5.30pm.

If the patient’s next assessment date has been scheduled include the date in this section.

Ordering form

This section on the HOOF provides space to input any additional information which is related to the patient.
Holiday information should be put in this section making sure to include all relevant information mentioned in section 6.

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

NIV = Non invasive ventilation

CPAP = Continuous positive airways pressure

Conserving device contra indicated- Tick this box if the patient will be unable to use a conserving device with their cylinders

This section of the HOOF needs to be fully completed with the details of the health care professional prescribing the oxygen for the patient.
Please sign and date the HOOF and clearly print the healthcare professionals name and position.
To allow a quick and accurate service for any correspondence please supply a telephone and fax number for any queries regarding this HOOF form within section 15.
The fax number in this section also allows Air Products to send a confirmation of the HOOF order for your records directly to the clinician once the order has been processed.

If there are any further questions regarding completing a HOOF please contact Air Products
on 0800 373580.

Once completed submit the HOOF to Air Products on fax number 0800 214709.

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.