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.

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.

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

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

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

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-
Booking name and reference where appropriate.

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

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.
![]()
If the patient’s next assessment date has been scheduled include the date in this section.


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

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.