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Get the free LIVTENCITY (maribavir) - PATIENT START FORM - Takeda

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Haven UrologyPatient Enrollment Form t. 1 (866) 3523211 | e. haven@sentrex.com1Fax completed enrollment to: 1 (866) 2833209Patient InformationName: (First, Last) Date of Birth: (ddmmmyyyy)Gender:FemaleMedical
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01
Obtain a prescription for Livtencity (maribavir) from your healthcare provider.
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Read the medication guide provided with the prescription carefully.
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Take Livtencity exactly as prescribed, usually twice a day with or without food.
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Measure the dose accurately using the provided dosing device or a measuring spoon.
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Swallow the tablet whole; do not crush or chew it.
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Keep track of your doses and refill your prescription in a timely manner.

Who needs livtencity maribavir - patient?

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Patients with proven or suspected cytomegalovirus (CMV) infection who are immunocompromised.
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Individuals who are at high risk of developing CMV disease due to conditions such as organ transplants or advanced HIV.
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Livtencity (maribavir) is an antiviral medication used to treat certain viral infections, especially in patients with compromised immune systems.
Healthcare providers prescribing livtencity (maribavir) for treatment may be required to file patient information with relevant health authorities.
Healthcare providers must complete the associated forms by entering patient details, treatment information, and reporting outcomes as required by regulations.
The purpose is to ensure proper tracking and reporting of patients receiving livtencity (maribavir) for safety monitoring and effective healthcare management.
Essential information includes patient demographics, treatment regimen, response to therapy, and any adverse effects observed.
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