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Gov. WEBPBSC-0259-17 January 2017 SC Medicaid PAB Fax Form 12. 15. 16. docx PATIENT NAME PATIENT ID 9. PAGE 1 OF 2 CONTINUED ON PAGE 2 www. BlueChoiceSCMedicaid.com BlueChoice HealthPlan is an independent licensee of the Blue Cross and Blue Shield Association. BlueChoice HealthPlan has contracted with Amerigroup Partnership Plan LLC an independent company for services to support administration of Healthy Connections. Yes No Patient has had a previous trial medication samples/coupons/discount...
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Consideration as a trial is the process by which an individual or organization submits a request to participate in a trial or study.
Any individual or organization interested in participating in a trial or study is required to file consideration as a trial.
To fill out consideration as a trial, the individual or organization must provide relevant information about their background, medical history, and reasons for wanting to participate in the trial.
The purpose of consideration as a trial is to determine eligibility and suitability for participation in a trial or study.
Information such as personal details, medical history, current medications, and reasons for wanting to participate must be reported on consideration as a trial.
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