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Medical prior authorization format completed form to: 877.974.4411 toll-free, or 616.942.8206Commercial (Traditional)
Commercial (Individual/Optimized)
Medicaid
Urgent (life-threatening)
Monument
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How to fill out imlygic 106ml
How to fill out imlygic 106ml
01
Wash your hands before handling the imlygic 106ml vial.
02
Use a sterile syringe to withdraw the required amount of imlygic 106ml from the vial.
03
Choose a clean and dry injection site on your skin, preferably the thigh or stomach area.
04
Clean the injection site with an alcohol swab and let it dry.
05
Remove the needle cap from the syringe and hold it like a pencil.
06
Pinch the skin slightly at the injection site to create a firm surface.
07
Insert the needle into the skin at a 90-degree angle, making sure it goes all the way in.
08
Slowly push the plunger down to inject the imlygic 106ml into the skin.
09
Once the syringe is empty, remove the needle from the skin.
10
Dispose of the used syringe and needle in a sharps container.
11
Wash your hands again after completing the injection.
Who needs imlygic 106ml?
01
Imlygic 106ml is typically prescribed for adults with unresectable melanoma (skin cancer) that has spread to nearby lymph nodes or other parts of the body.
02
It is not suitable for individuals who have had a severe allergic reaction to imlygic 106ml or any of its ingredients.
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Only a healthcare professional can determine if imlygic 106ml is appropriate for a specific patient.
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What is imlygic 106ml?
Imlygic 106ml is a prescription medication used for the treatment of melanoma by utilizing genetically modified oncolytic herpes simplex virus.
Who is required to file imlygic 106ml?
Healthcare providers administering Imlygic and clinics or facilities offering this treatment are typically required to file the appropriate documentation.
How to fill out imlygic 106ml?
Filling out Imlygic 106ml involves providing patient information, treatment details, and specific dosage administered according to the guidelines provided by the manufacturer.
What is the purpose of imlygic 106ml?
The purpose of Imlygic 106ml is to treat patients with unresectable melanoma by stimulating the immune system to attack cancer cells.
What information must be reported on imlygic 106ml?
Information to report includes patient identification, treatment regimen, response to therapy, and any adverse effects encountered during treatment.
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