Get the free Lumasiran (Oxlumo) Referral Form

Eurasian (Column) Referral Formulas complete the following and fax with clinical documentation to: 720.870.2414 Referral Process 1. PATIENT INFORMATION (*indicates a required field)2. PHYSICIAN INFORMATION

How to fill out lumasiran oxlumo referral form

How to fill out lumasiran oxlumo referral form

1. Obtain the lumasiran oxlumo referral form from the healthcare provider or the pharmaceutical company.
2. Provide all necessary information such as patient's name, date of birth, contact information, medical history, and insurance details.
3. Ensure the form is filled out accurately and completely to avoid any delays in processing.
4. Submit the completed form to the designated recipient as per the instructions provided on the form.

Who needs lumasiran oxlumo referral form?

1. Individuals who have been diagnosed with primary hyperoxaluria type 1 (PH1) and deemed eligible for treatment with lumasiran oxlumo.
2. Healthcare providers who are prescribing lumasiran oxlumo for their patients.

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What is lumasiran oxlumo referral form?

The lumasiran oxlumo referral form is a document used to refer patients for treatment with the medication lumasiran, also known as Oxlumo, for a specific medical condition.

Who is required to file lumasiran oxlumo referral form?

Healthcare providers or medical professionals are required to file the lumasiran oxlumo referral form on behalf of their patients.

How to fill out lumasiran oxlumo referral form?

The lumasiran oxlumo referral form can be filled out by providing the necessary patient information, medical history, and details about the healthcare provider referring the patient.

What is the purpose of lumasiran oxlumo referral form?

The purpose of the lumasiran oxlumo referral form is to facilitate the referral process for patients who may benefit from treatment with lumasiran, ensuring they receive the appropriate care.

What information must be reported on lumasiran oxlumo referral form?

The lumasiran oxlumo referral form typically requires information such as patient name, date of birth, medical condition, healthcare provider details, and reasons for the referral.