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This form allows eligible patients to enroll in the XYNTHA Trial Prescription Program for receiving complimentary product, including instructions for both patients and healthcare providers.
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How to fill out xyntha trial prescription program
How to fill out XYNTHA Trial Prescription Program Enrollment Form
01
Begin by gathering all necessary personal and medical information.
02
Fill out the patient's full name, date of birth, and contact details in the designated fields.
03
Include the insurance information, if applicable, ensuring it's accurate.
04
Provide details about the patient's medical history related to hemophilia and other relevant conditions.
05
Complete the section regarding the prescribing healthcare professional's information.
06
Review the form for completeness and accuracy before submitting.
07
Submit the form to the designated address or follow the specified submission method.
Who needs XYNTHA Trial Prescription Program Enrollment Form?
01
Patients diagnosed with hemophilia who are seeking to try XYNTHA.
02
Healthcare professionals who manage the treatment of hemophilia patients.
03
Individuals involved in the administration of treatment programs related to hemophilia.
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People Also Ask about
Who makes xyntha?
XYNTHA® (antihemophilic factor (recombinant)) XYNTHA - U.S. Medical Information Page - patient information, ways to contact Pfizer Medical & other resources.
How is xyntha administered?
Verify proper needle placement. Inject the reconstituted XYNTHA product intravenously over several minutes. The rate of administration should be determined by the patient's comfort level.
What is the indication of Xyntha?
XYNTHA, Antihemophilic Factor (Recombinant), is indicated for use in adults and children with hemophilia A (congenital factor VIII deficiency) for: On-demand treatment and control of bleeding episodes. Perioperative management. Routine prophylaxis to reduce the frequency of bleeding episodes.
How to reconstitute XYNTHA?
Gently advance plunger rod by pushing until the 2 stoppers inside meet and all the diluent is transferred to the chamber containing the XYNTHA powder. Swirl gently several times until powder is dissolved. Slowly advance the plunger rod until most, but not all, of the air is removed from the drug product chamber.
How is Alphanate administered?
Administration of ALPHANATE ALPHANATE is for intravenous use only after reconstitution. Patients should use plastic disposable syringes. ALPHANATE should not be refrigerated after reconstitution.
How is factor VIII administered?
Administration. Factor VIII is generally administered as a slow IV push (bolus injection). Continuous infusion of Factor VIII is indicated for patients requiring admission for severe bleeds or surgical procedures. Factor VIII replacement for such patients should be managed in consultation with Clinical Haematology.
How do you administer antihemophilic factor?
First, invert the Novoeight® vial and slowly draw the solution into the syringe. Next, detach the syringe from the vial adapter by turning the syringe counterclockwise. Attach the syringe to the luer end of an infusion needle set. Inject the reconstituted Novoeight® intravenously slowly over 2 to 5 minutes.
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What is XYNTHA Trial Prescription Program Enrollment Form?
The XYNTHA Trial Prescription Program Enrollment Form is a document required for participating in a clinical trial that involves the XYNTHA medication, typically used for treating hemophilia.
Who is required to file XYNTHA Trial Prescription Program Enrollment Form?
Patients who are eligible and wish to participate in the XYNTHA clinical trial must file the Enrollment Form, which is usually completed by healthcare providers on behalf of the patients.
How to fill out XYNTHA Trial Prescription Program Enrollment Form?
To fill out the XYNTHA Trial Prescription Program Enrollment Form, applicants need to provide accurate personal information, medical history, and consent for participation, ensuring all required sections are completed and signed.
What is the purpose of XYNTHA Trial Prescription Program Enrollment Form?
The purpose of the Enrollment Form is to gather necessary information to determine patient eligibility for the clinical trial and to document consent for participation in the trial.
What information must be reported on XYNTHA Trial Prescription Program Enrollment Form?
The form must report personal identification details, medical history, current medications, and any other relevant health information that may impact eligibility for the trial.
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