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Aducanumab (ADUHELMTM) Referral Form Please complete the following form and send to the Alzheimer's Disease Therapeutic Care Management Center:FAX: 8442761706 EMAIL BOX: aduhelm@soleohealth.com PHONE:
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How to fill out aduhelm referral form
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01
To fill out the aduhelm referral form, follow these steps:
02
Start by downloading the aduhelm referral form from the official website.
03
Read the form instructions carefully to understand the required information.
04
Provide your personal and contact details in the designated fields, such as name, address, phone number, and email.
05
Fill in the patient's details, including their name, date of birth, and relevant medical history.
06
Specify the reason for the referral and the healthcare provider who is referring the patient.
07
Make sure to include any supporting documents or medical reports that may be required.
08
Review the completed form for accuracy and completeness.
09
Sign and date the form.
10
Submit the filled-out aduhelm referral form to the appropriate recipient, as instructed.
Who needs aduhelm referral form?
01
The aduhelm referral form is typically needed by healthcare providers, clinicians, or physicians who are referring a patient for aduhelm treatment.
02
It is also required by patients who wish to seek aduhelm treatment and have been advised by their healthcare provider to fill out a referral form.
03
In general, anyone who meets the eligibility criteria for aduhelm treatment may need to fill out the referral form as part of the treatment process.
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What is aduhelm referral form?
Aduhelm referral form is a form used to refer patients for treatment with the drug Aduhelm.
Who is required to file aduhelm referral form?
Healthcare providers who wish to refer their patients for treatment with Aduhelm are required to file the referral form.
How to fill out aduhelm referral form?
The aduhelm referral form can be filled out online or in paper form. Healthcare providers must provide accurate patient information and medical history.
What is the purpose of aduhelm referral form?
The purpose of the aduhelm referral form is to facilitate the referral process for patients who may benefit from treatment with Aduhelm.
What information must be reported on aduhelm referral form?
The aduhelm referral form must include patient demographics, medical history, current medications, and reason for referral.
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