Subcutaneous immune globulin (SCIG) is a blood product licensed in Canada for the treatment of patients with primary immunodeficiency disease. Unlike IVIG, which is infused in a hospital, SCIG can be infused at home by a patient who has been trained.

 

This section provides templates for health authorities to develop and customize their own SCIG program. 

 Document Date: Dec 2011

SCIG Resource Kit

(for downloading and customization where appropriate) 

 SCIG Resource Kit Cover Sheet

 

 Provincial Guidelines for SCIG Home Infusion Programs

 
 Training Materials  

Teaching Plan

 

Patient Post-Training Quiz

 

Patient Skills Assessment

 

Patient Evaluation of Training

 

Pre-Training Letter to GP

 

Post-Training Letter to GP

 
 Patient Handouts
 

Patient Brochure

 

Patient Handbook

 

Quick Reference Guide: How to draw SCIG into a syringe

 

Infusion Log

 
 Form and Letter Templates
 

Patient Referral Form

 

Patient Consent and Participation Agreement 

 

Patient Intake Form 

 

SCIG Patient Enrolment Form - Vivaglobin 

 

SCIG Patient Enrolment Form - Gamunex 

 

SCIG Patient Enrolment Form - Hizentra

 

SCIG Product Order / Pick-up Form - Vivaglobin 

 

SCIG Product Order / Pick-up Form - Gamunex 

 

SCIG Product Order / Pick-up Form - Hizentra

 

Travel Letter - Vivaglobin

 

Travel Letter - Gamunex

 

Travel Letter - Hizentra 

 

TMS IVIG Request Process