Get the free Austedo® Xr Patient Enrollment

This document is a patient enrollment form for AUSTEDO® XR (Deutetrabenazine), used for patients diagnosed with Tardive Dyskinesia (TD) and Huntington\'s Chorea (HD). It requires patient information, insurance details, clinical information, prescriber information, and prescription information including initial titration dosage instructions.

How to fill out austedo xr patient enrollment

How to fill out austedo xr patient enrollment

1. Obtain the Austedo XR patient enrollment form from your healthcare provider or the manufacturer's website.
2. Fill out the patient's personal information including name, date of birth, and contact details.
3. Provide details about the patient's medical history and diagnosis related to movement disorders.
4. Complete the insurance information section to verify coverage for Austedo XR.
5. Include the prescribing physician's information and signature.
6. Review the completed form for accuracy and completeness.
7. Submit the enrollment form to the designated contact or insurance company as instructed.

Who needs austedo xr patient enrollment?

1. Patients diagnosed with Tourette's disorder.
2. Patients with chorea associated with Huntington's disease.
3. Individuals who require long-term management of their movement disorders with Austedo XR.

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What is austedo xr patient enrollment?

Austedo XR patient enrollment is a process that allows patients to gain access to Austedo XR, a medication used for the treatment of movement disorders.

Who is required to file austedo xr patient enrollment?

Patients who are prescribed Austedo XR, healthcare providers, and pharmacies involved in the dispensing of the medication are typically required to file for enrollment.

How to fill out austedo xr patient enrollment?

To fill out the Austedo XR patient enrollment, patients or their caregivers must complete a specific enrollment form, providing necessary details such as personal information, diagnosis, and insurance information.

What is the purpose of austedo xr patient enrollment?

The purpose of Austedo XR patient enrollment is to ensure that patients receive proper access to the medication, which may include insurance coverage verification and assistance programs.

What information must be reported on austedo xr patient enrollment?

Information required for Austedo XR patient enrollment typically includes the patient's name, contact information, medical history, diagnosis, insurance information, and prescription details.