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1050 Patrol Rd Jeffersonville, IN 47130 Phone: 8552422241 Fax: 8773424596Sublocade (extended release) Injection CII Enrollment Form (please use black ink)PATIENT INFORMATIONPRESCRIBER INFORMATIONPlease
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What is sublocade injection ciii enrollment?
Sublocade injection CIII enrollment is a process for healthcare providers to enroll patients in a program for receiving medication-assisted treatment for opioid use disorder.
Who is required to file sublocade injection ciii enrollment?
Healthcare providers who are prescribing Sublocade injection CIII to patients for the treatment of opioid use disorder are required to file the enrollment.
How to fill out sublocade injection ciii enrollment?
To fill out the Sublocade injection CIII enrollment, healthcare providers need to provide patient information, medical history, and complete the required forms.
What is the purpose of sublocade injection ciii enrollment?
The purpose of Sublocade injection CIII enrollment is to ensure proper monitoring and management of patients receiving medication-assisted treatment for opioid use disorder.
What information must be reported on sublocade injection ciii enrollment?
Information such as patient demographics, medical history, previous treatment for opioid use disorder, and any known allergies or contraindications must be reported on the Sublocade injection CIII enrollment.
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