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ONTARIO (VEDOLIZUMAB) ORDERS P: 877.365.5566 | F: 855.889.2946 PATIENT INFORMATION:Fax completed form, insurance information, and clinical documentation to 855.889.2946Patient Name: ___ DOB: ___ Phone:
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Consult with a healthcare provider to determine if F 8558892946 Entyvio Vedolizumab is the right treatment for you.
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Follow the dosage instructions provided by your healthcare provider.
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F 8558892946 Entyvio Vedolizumab is typically prescribed for patients with moderate to severe ulcerative colitis or Crohn's disease who have not responded to other treatments.
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It is important to consult with a healthcare provider to determine if this medication is appropriate for your specific condition.
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Form 8558892946 is a specific form associated with the administration or reimbursement for Entyvio (Vedolizumab), a medication used to treat certain autoimmune diseases such as ulcerative colitis and Crohn's disease.
Healthcare providers and institutions that administer Entyvio and wish to receive reimbursement or report on the medication's usage are required to file Form 8558892946.
Filling out Form 8558892946 involves providing accurate patient information, the details of the healthcare provider or facility administering the drug, and other necessary documentation required by the form's guidelines.
The purpose of Form 8558892946 is to ensure proper reporting and reimbursement for the administration of Entyvio, tracking its use, and maintaining compliance with healthcare regulations.
The form requires reporting information such as patient demographics, the dosage of Entyvio administered, the healthcare provider's identification details, and any adverse effects observed.
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