Get the free Celgene Prescription Referral Form - Avella Specialty ...

Faxed prescriptions will only be accepted from a prescribing practitioner. Patients must bring an original prescription to the pharmacy. Prescribers are reminded patients may choose any pharmacy of

How to fill out celgene prescription referral form

How to fill out celgene prescription referral form

1. To fill out the Celgene prescription referral form, follow these steps:
2. Begin by downloading the referral form from the Celgene website or obtain a physical copy from your healthcare provider.
3. Provide your personal information, including your full name, contact details (address, phone number, email), and date of birth.
4. Specify the name of the medication you are being referred for and provide any relevant details or dosage instructions.
5. Attach any supporting documentation required by Celgene, such as medical reports or test results.
6. Indicate your preferred pharmacy or healthcare provider where you would like the prescription to be sent.
7. Review the completed form for accuracy and make any necessary corrections.
8. Sign and date the form to certify that the information provided is true and accurate.
9. Submit the filled-out Celgene prescription referral form to the designated address or fax number mentioned on the form.
10. If submitting electronically, ensure that you have followed the appropriate method of submission as instructed by Celgene.
11. Keep a copy of the filled-out form for your records.
12. It is always advisable to consult with your healthcare provider or pharmacist for specific instructions on filling out the Celgene prescription referral form.

Who needs celgene prescription referral form?

1. The Celgene prescription referral form is typically required by patients who have been prescribed a medication manufactured or supplied by Celgene.
2. These medications are often used for the treatment of various cancers, inflammatory disorders, and immune system-related conditions.
3. If your healthcare provider determines that you need a Celgene medication and requires additional authorization or special access, they may ask you to fill out the Celgene prescription referral form.
4. This form serves as a means of communicating and coordinating between your healthcare provider, Celgene, and the designated pharmacy or healthcare facility.

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