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If you are not the intended recipient please notify the sender immediately. Office use only HUMIRACMS2016MAY-W.doc What is the patient s diagnosis Moderately to severely active Rheumatoid Arthritis Active Psoriatic Arthritis Moderate to Severe Chronic Plaque Psoriasis Pediatric Crohn s Disease Active Ankylosing Spondylitis Other Ankylosing Spondylitis Does the patient have history of failure intolerance or contraindication to 2 NSAIDs Yes No Ulcerative Colitis Is the patient corticosteroid...

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