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SIL IQ REMS Program PatientPrescriber Agreement Form Instructions for Prescribers 1. Sign this form along with your patient and place it in the patients chart. 2. Tear off the bottom portion and provide
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How to fill out siliq rems program
How to fill out siliq rems program
01
To fill out the Siliq REMS program, follow these steps:
1. Obtain the Siliq REMS program packet from your healthcare provider or pharmacy.
2. Read all the instructions and information provided in the packet.
3. Fill in your personal details, including your full name, address, phone number, and date of birth.
4. Answer all the required medical history questions accurately and truthfully.
5. Provide any additional information or documentation that may be necessary.
6. Sign and date the necessary forms.
7. Submit the completed forms to your healthcare provider or pharmacy.
8. Follow any additional instructions provided by your healthcare provider or pharmacy.
Who needs siliq rems program?
01
The Siliq REMS program is designed for individuals who have been prescribed Siliq (brodalumab) for the treatment of moderate to severe plaque psoriasis. It is an FDA-mandated program aimed at ensuring the safe use of this medication due to its potential risks, including suicidal thoughts and behavior.
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What is siliq rems program?
Siliq REMS program is a Risk Evaluation and Mitigation Strategy program designed to manage known or potential serious risks associated with the use of the medication Siliq.
Who is required to file siliq rems program?
Healthcare providers who prescribe or dispense Siliq, as well as patients who are prescribed Siliq, are required to participate in the Siliq REMS program.
How to fill out siliq rems program?
To fill out the Siliq REMS program, healthcare providers and patients must complete the necessary forms and training materials provided by the program.
What is the purpose of siliq rems program?
The purpose of the Siliq REMS program is to ensure that the benefits of using Siliq outweigh the potential risks by educating healthcare providers and patients about the safe use of the medication.
What information must be reported on siliq rems program?
The Siliq REMS program requires reporting of adverse events, pregnancy exposures, and enrollment information for patients prescribed Siliq.
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