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BioScrip BioRx/ThriveRx Coram By signing this authorization Authorization I hereby certify and agree to the following Walgreens Infusion Services No preference Prescriber s Signature Date No stamped signatures permitted Any questions Agent of Prescriber Remember to complete the Patient Authorization Front Call NPS AdvantageTM 1-855-TEAM-NPS 832-6677 9 00am to 6 00pm EST GATTEX is a registered trademark of NPS Pharmaceuticals Inc. 2014 NPS Pharmaceuticals Inc. All rights reserved....
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What is gattex referral formtip sheet?
Gattex referral formtip sheet is a form that provides information about the referral process for patients prescribed with Gattex.
Who is required to file gattex referral formtip sheet?
Healthcare providers and pharmacies are required to file the Gattex referral formtip sheet.
How to fill out gattex referral formtip sheet?
The Gattex referral formtip sheet can be filled out online or submitted through fax with the required patient and prescribing healthcare provider information.
What is the purpose of gattex referral formtip sheet?
The purpose of Gattex referral formtip sheet is to ensure proper coordination between healthcare providers and pharmacies for the prescription and delivery of Gattex to patients.
What information must be reported on gattex referral formtip sheet?
The Gattex referral formtip sheet must include patient demographics, prescribing healthcare provider information, prescription details, and insurance information.
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