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PHOSPHINE REMS ProgramPharmacy Enrollment Form InstructionsProbuphine () implant is only available through the Porcupine Risk Evaluation and Mitigation Strategy (REMS) Program. Before Porcupine is
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How to fill out probuphine rems program
How to fill out probuphine rems program
01
To fill out the Probuphine REMS Program, follow these steps:
02
Start by providing the necessary patient information, including their name, date of birth, and contact details.
03
Next, fill in the medical history of the patient, including any previous treatments for opioid dependence.
04
Provide the prescribing physician's information, including their name, contact details, and DEA number.
05
Indicate the dose and duration of Probuphine treatment for the patient.
06
Confirm that the patient understands the risks and benefits of Probuphine treatment by having them sign the informed consent form.
07
Attach any relevant lab test results or medical documentation as required.
08
Submit the completed Probuphine REMS Program form to the designated authority for review and approval.
09
Wait for the response from the authority regarding the approval or any additional information required.
10
If approved, the patient can proceed with receiving Probuphine treatment as prescribed.
11
It is important to regularly monitor the patient's progress and comply with any additional requirements or reporting as per the Probuphine REMS Program guidelines.
Who needs probuphine rems program?
01
The Probuphine REMS Program is designed for individuals who require treatment for opioid dependence and have been specifically prescribed Probuphine.
02
This program is primarily intended for patients who have had inadequate clinical response to prior opioid dependence treatments and meet the eligibility criteria for Probuphine use.
03
It is important to note that the Probuphine REMS Program is for patients who have been deemed suitable candidates for Probuphine by their healthcare providers and have committed to the required monitoring and follow-up care.
04
Healthcare providers and professionals involved in prescribing and monitoring Probuphine treatment also need to be aware of and comply with the Probuphine REMS Program.
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What is probuphine rems program?
Probuphine REMS program is a Risk Evaluation and Mitigation Strategy program designed to ensure safe use of probuphine implants for the treatment of opioid dependence.
Who is required to file probuphine rems program?
Healthcare providers, pharmacies, and patients are required to participate in the probuphine REMS program.
How to fill out probuphine rems program?
The probuphine REMS program can be filled out online through the program's website or by contacting the program administrator.
What is the purpose of probuphine rems program?
The purpose of the probuphine REMS program is to mitigate the risks associated with probuphine implants and ensure safe use by patients.
What information must be reported on probuphine rems program?
Information such as patient demographics, prescribing healthcare provider information, and implantation procedure details must be reported on the probuphine REMS program.
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