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Patient Name: ___ 477 W Horton Rd Bellingham, WA 98226 Phone (360) 9334892 Fax (360) 9331197Date of Birth: ___ Wt: ___Ht:___ Allergies: ___Infliximab (or biosimilar) Order Form Has the patient previously
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01
Go to the Contact Us page on the Infusion website.
02
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03
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Click on the Submit button to send your contact request to the Infusion team.
Who needs contact us - infusion?
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What is contact us - infusion?
Contact us - infusion is a form used to report information related to infusion services provided.
Who is required to file contact us - infusion?
Healthcare providers who administer infusion services are required to file contact us - infusion.
How to fill out contact us - infusion?
Contact us - infusion can be filled out online or submitted in paper form with required information about infusion services provided.
What is the purpose of contact us - infusion?
The purpose of contact us - infusion is to provide a detailed report of infusion services provided by healthcare providers.
What information must be reported on contact us - infusion?
Contact us - infusion must include details such as patient name, date of service, type of infusion, and healthcare provider information.
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