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Doctor s mailing address is If I cancel this authorization then Doctor and Insurer will stop providing sanofi-aventis with information about me. I also know that I can cancel this authorization at any time by writing to my Doctor or sanofi-aventis. For full prescribing information including BOXED WARNINGS please call 1-800-633-1610 or visit www. sanofi-aventis. Information supplied on this form will be held in strict confidence and will only be used for the administration of this program....
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What is form pactsm program?
Form pactsm program is a form used to report certain information to the authorities.
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