Our Response to the IV Fluid Shortage

Like most U.S. hospitals, Cincinnati Children's is affected by the IV fluid shortage caused by damage to Baxter International's North Carolina production facility during Hurricane Helene. Our teams will continue to watch this situation and will provide any updates as needed.

Schedule an Appointment
Directions
International
Billing
Sign in to MyChart
Ways to Help
Donate Now

Navigation

Patients and Families

Patients and Family Home Schedule an Appointment Services and Specialties Find a Doctor Visiting Cincinnati Children's Health Library

Additional Resources
Clinical Trials/Research Studies Patient Resources Vaccine Resources Ongoing Support Resources
Healthcare Professionals

Healthcare Professionals Home Services and Specialties Clinical Trials Find a Doctor Refer a Patient

Additional Resources
Browse Careers Patient Resources Provider Resources Continuing Professional Education Clinical Training Programs Graduate Medical Education Clinical Laboratories Nursing
Researchers

Research Home Find a Researcher Research Areas Education and Training

Additional Resources
Shared Facilities Research Support Services Research Foundation Funded Training Browse Careers
Search
I want to

Sign in to MyChart Pay a Bill Schedule an Appointment Get an Online Second Opinion Obtain Medical Records Find an Urgent Care Find a Specialty Find a Doctor Find a Location Browse Careers Make a Donation

Schedule an Appointment Directions International Billing Sign in to MyChart Ways to Help Donate Now

Popular search terms

Coronavirus Careers Urgent Care MyChart Neurology Volunteer

Home
Home

Home
Special Forms
Signature Services Data Collection Form

Section Navigation

Home

About Cincinnati Children's
Careers
Critical Care Building
Contact Us
Education and Training
Servicios para Nuestros Pacientes
Giving
Locations and Directions
Search
Newsroom
Patients and Family
Primary Care
Privacy and Data Security Notices
Patient and Family Resources
Healthcare Professionals
Researchers
Schedule an Appointment
Search
Site Information

Signature Services Data Collection Form

Patient First Name

Patient Middle Name

Patient Last Name

Date of Birth of Patient

Guardian Name

Guardian Contact Number

Guardian email address

Street address

City

State

Zip Code

Referring Party (Name of CCHMC connection)

Divisions Requested (i.e. cardiac, neurology, CBDI, etc.)

Abnormal Weight Gain

ADHD Center

Adolescent Medicine / Teen Health Center

Aerodigestive

Allergy Clinic

Behavioral Medicine & Clinical Psychology

Brachial Plexus Clinic

Breast Feeding Clinic

Cardiology

Cardiothoracic Surgery

Center for Better Health and Nutrition (CBHD) - Non Surgical

Cerebral Palsy Clinic

Chronic Pain Management

Chronic Pain Management - FIRST program

Colorectal Surgery

Craniofacial Center

Dentistry

Dermatology

Developmental & Behavioral Pediatrics

Diabetes

Endocrinology

ENT (Otolaryngology)

Feeding Team

Fetal Surgery

Gastroenterology-GI

Gynecology (Pediatric & Adolescent)

Head Injury Clinic

Hemangioma & Vascular Malformation Team

Hematology-Oncology

Human Genetics

Hypertension / Cholesterol Clinic

ICU - Admitted

Infectious Diseases-ID

Inpatient

International Adoption Center-IAC

Mayerson Center for Safe & Healthy Children

Nephrology

Neurology

Neurosurgery

Nutrition

Ophthalmology/Eye Clinic

Orthopedics

Other

Perlman Center/Cerebral Palsy Program

Physical Medicine & Rehab (not OT/PT)

Plastic Surgery

Psychiatry

Pulmonary Medicine

Reading/Literacy

Rheumatology

Sleep Center

Speech Therapy

Sports Medicine

Surgery (General & Thoracic Surgery)

Urology

Weight Loss Program - Surgical

Please provide additional details of request (symptoms/health issue, diagnosis, medical history)

Process (Description of process to complete the request)

Time: Amount of time spent completing task (add up time if over days)

Connection: to Development Team member (include name)

Outcome: Conclusion of services received

Follow-up: Any necessary feedback received from patients/families

Record Type

Owner ID

Connect With Us

Patients & Family

Research & Science Young & Healthy Podcast

Explore Explore

Our Commitment to Diversity, Equity and Inclusion (DEI)
Locations and Directions
Clinical Services
Health Library
Visitor and Patient Information
Clinical Trials
Events

About Us About Us

About Cincinnati Children's
Careers
Newsroom
Contact Us
Download Our Cincinnati Children's App
Terms of Use
Privacy and Data Security Notices
Non-Discrimination Notice

Give Today

3333 Burnet Avenue, Cincinnati, Ohio 45229-3026

Our Response to the IV Fluid Shortage

HomeHome

Signature Services Data Collection Form

Connect With Us

Home
Home