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2 PRESCRIBER INFORMATION Prescription & Enrollment Formalin (pitolisant tablets) for oral use Four simple steps to submit your referral. Four simple steps to submit your referral.1 PATIENT INFORMATION
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01
To fill out the Myalept REMS Program Prescriber form, follow these steps:
02
Access the Myalept REMS Program Prescriber form online.
03
Fill in the required personal and professional information, such as name, address, and medical license number.
04
Provide information about your medical practice, including its name and address.
05
Answer the questions regarding your familiarity with Myalept and its indication for use.
06
Indicate whether you have reviewed the Myalept Prescribing Information, including the Boxed Warning.
07
Agree to comply with the requirements of the Myalept REMS Program.
08
Submit the completed form online or by mail, as specified in the instructions.

Who needs myalept rems program prescriber?

01
The Myalept REMS Program Prescriber is needed by healthcare professionals who intend to prescribe Myalept (metreleptin) for their patients.
02
This program is specifically designed to ensure the safe use of Myalept, a medication used to treat complications of leptin deficiency or resistance in patients with generalized lipodystrophy.
03
Healthcare professionals who meet the prescribing requirements outlined by the Myalept REMS Program must complete the prescriber form to participate in the program and prescribe Myalept to eligible patients.
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Myalept REMS program prescriber refers to a healthcare provider who is certified to prescribe Myalept, a medication used to treat complications of leptin deficiency.
Healthcare providers who wish to prescribe Myalept are required to enroll in and comply with the Myalept REMS program.
To fill out the Myalept REMS program prescriber form, healthcare providers must complete the registration form provided by the program, ensuring all required information is accurately filled in before submitting.
The purpose of the Myalept REMS program prescriber is to ensure the safe use of Myalept, monitor patient outcomes, and minimize risks associated with its administration.
Prescribers must report their qualifications, patient demographics, treatment plans, and any adverse events related to Myalept therapy.
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