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Get the free ULTOMIRIS (ravulizumab-cwvz) injection, for intravenous use

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Ultomiris (ravulizumabcwvz) Referral Form Patient Preferred Clinic (select one): ___ PATIENT INFORMATION DOB:Referral Status:New ReferralPatient Name:Updated Recorder RenewalPatient Phone: Patient
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01
Wash hands thoroughly with soap and water.
02
Prepare the injection site by cleaning with an alcohol swab.
03
Allow the vial of Ultomiris to reach room temperature before use.
04
Use a clean syringe to withdraw the prescribed dose of Ultomiris.
05
Inject the medication subcutaneously, following proper injection technique.
06
Properly dispose of any needles or syringes in a sharps container.

Who needs ultomiris ravulizumab-cwvz injection for?

01
Ultomiris ravulizumab-cwvz injection is typically prescribed for patients with paroxysmal nocturnal hemoglobinuria (PNH), a rare and life-threatening blood disorder characterized by the destruction of red blood cells.
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Ultomiris ravulizumab-cwvz injection is used to treat paroxysmal nocturnal hemoglobinuria (PNH) and atypical hemolytic uremic syndrome (aHUS).
Ultomiris ravulizumab-cwvz injection is typically prescribed by healthcare providers and administered by trained medical professionals.
Ultomiris ravulizumab-cwvz injection should be administered by a healthcare professional following the instructions provided by the manufacturer.
The purpose of ultomiris ravulizumab-cwvz injection is to inhibit the terminal complement pathway, preventing red blood cell destruction in patients with PNH and aHUS.
Information such as patient demographics, medical history, dosage administered, and any adverse reactions must be reported on ultomiris ravulizumab-cwvz injection forms.
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