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FAX 833.329.4738Vyvgart (efgartigimod alfafcab, efgartigimod alfa and hyaluronidaseqvfc) Provider Order Form rev. 11/17/2023Patient Information Patient Name:DOB:Patient Phone: NKDAPatient Email: Allergies:Patient
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Vyvgart (efgartigimod alfa-fcab) is a therapeutic drug used to treat autoimmune diseases by modulating the immune system.
Patients prescribed vyvgart efgartigimod alfa-fcab efgartigimod by their healthcare providers are typically required to file necessary documentation for insurance and reimbursement.
To fill out vyvgart efgartigimod alfa-fcab efgartigimod, patients must complete forms provided by their healthcare provider or insurance company, detailing personal and medical information.
The purpose of vyvgart efgartigimod alfa-fcab efgartigimod is to reduce pathogenic antibodies in patients with autoimmune conditions, thereby alleviating their symptoms.
Information that must be reported includes patient identity, treatment history, dosage administered, and any adverse reactions observed.
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