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Service Benefit Plan
P.O. Box 52080 MC 139
Phoenix, AZ 850722080
Attn. Clinical ServicesYESCARTA
(MEDICAL BENEFIT ONLY)
PRESCRIBER REQUEST Format: 18773784727Additional information
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01
Start by identifying the medication you are reviewing.
02
Gather all the necessary information about your experience with the medication, including the dosage, frequency, and duration of use.
03
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04
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05
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06
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08
Provide suggestions or recommendations for others considering this medication.
09
Conclude your review by summarizing your overall opinion and final thoughts about the medication.
10
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Who needs review for this medication?
01
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02
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