IV Therapy Medical Eligibility & Exclusion Information

This document outlines general safety criteria used to determine eligibility for IV therapy services.

IV therapy is provided for hydration and wellness support only and is not intended to diagnose, treat, cure,

or prevent disease.

Required Vital Sign Parameters

(Reviewed by clinician prior to treatment)

IV therapy may only be provided when vital signs fall within acceptable safety ranges:

Vital Acceptable Range

Blood Pressure 90–160 systolic / 50–100 diastolic

Heart Rate 50–110 bpm

Respiratory Rate 12–22 breaths/min

Oxygen Saturation ≥ 94% (room air)

Temperature < 100.4°F (38°C)

Blood Glucose (if indicated) ≥ 70 mg/dL

Absolute Exclusions

IV therapy is not provided if any of the following are present:

☐ Known allergy to IV ingredients, medications, or additives

☐ Chronic kidney disease, renal failure, or dialysis

☐ Congestive heart failure or fluid overload conditions

☐ Active infection or fever

☐ Pregnancy or breastfeeding

☐ Uncontrolled hypertension

☐ Active cancer under current treatment (unless cleared by provider)

☐ Current intoxication or impaired decision-making

☐ History of anaphylaxis to injectable therapies☐ Under 18 years of age

Relative Exclusions

May require provider review prior to treatment:

☐ Asthma or chronic lung disease

☐ Diabetes or blood sugar disorders

☐ Seizure disorder

☐ History of stroke or TIA

☐ Liver disease

☐ Autoimmune disease

☐ Bleeding disorders or anticoagulant use

☐ Gastric ulcers or gastrointestinal bleeding

☐ Migraines requiring prescription medication

☐ Recent hospitalization or surgery (within 30 days)

Medication & Symptom Review

IV therapy may not be appropriate if any of the following apply:

☐ Blood thinners or anticoagulants

☐ Steroids

☐ NSAIDs (including ketorolac)

☐ Diuretics

☐ GLP-1 or weight-loss medications

☐ Recent steroid or ketorolac injection

Symptoms requiring medical evaluation instead of IV therapy:

☐ Chest pain☐ Shortness of breath

☐ Severe headache

☐ Dizziness or fainting

☐ Nausea or vomiting

☐ Abdominal pain

☐ Swelling of legs or hands

☐ Confusion or altered mental status

Acknowledgment

IV therapy services are offered for hydration and wellness support only.

If exclusion criteria are present, IV therapy may not be appropriate and referral to medical care may be

recommended.

Individual responses vary.