Form preview

Get the free Natrelle Silicone-Filled Breast Implant Device Tracking Form

Get Form
Instructions for completing Allergan’s Natrelle Silicone-Filled Breast Implant Device Tracking Form. This form is to be used for notifying Allergan upon implantation, explantation, or disposal of
We are not affiliated with any brand or entity on this form
4,4
98,753 Reviews
4,5
11,210 Reviews
4,6
715 Reviews
4,6
789 Reviews

Get, Create, Make and Sign natrelle silicone-filled breast implant

Edit
Edit your natrelle silicone-filled breast implant form online
Type text, complete fillable fields, insert images, highlight or blackout data for discretion, add comments, and more.
Add
Add your legally-binding signature
Draw or type your signature, upload a signature image, or capture it with your digital camera.
Share
Share your form instantly
Email, fax, or share your natrelle silicone-filled breast implant form via URL. You can also download, print, or export forms to your preferred cloud storage service.

How to edit natrelle silicone-filled breast implant online

9.5
Ease of Setup
pdfFiller User Ratings on G2
9.0
Ease of Use
pdfFiller User Ratings on G2
Follow the steps below to use a professional PDF editor:
1
Log in to your account. Start Free Trial and register a profile if you don't have one.
2
Prepare a file. Use the Add New button. Then upload your file to the system from your device, importing it from internal mail, the cloud, or by adding its URL.
3
Edit natrelle silicone-filled breast implant. Replace text, adding objects, rearranging pages, and more. Then select the Documents tab to combine, divide, lock or unlock the file.
4
Get your file. Select your file from the documents list and pick your export method. You may save it as a PDF, email it, or upload it to the cloud.
It's easier to work with documents with pdfFiller than you can have ever thought. You can sign up for an account to see for yourself.

Uncompromising security for your PDF editing and eSignature needs

Your private information is safe with pdfFiller. We employ end-to-end encryption, secure cloud storage, and advanced access control to protect your documents and maintain regulatory compliance.
Learn more about security & compliance
GDPR
AICPA SOC 2
PCI
HIPAA
CCPA
FDA

How to fill out natrelle silicone-filled breast implant

Illustration

How to fill out Natrelle Silicone-Filled Breast Implant Device Tracking Form

01
Begin by entering your personal information in the designated fields, including your full name, address, and contact information.
02
Fill in the date of the implant surgery and the name of the surgeon who performed the procedure.
03
Specify the type of Natrelle Silicone-Filled Breast Implants you received by selecting the correct model and size from the provided list.
04
Indicate the serial number of each implant, which can usually be found on the implant packaging.
05
Complete any additional questions about your medical history and current health status as prompted on the form.
06
Review all the information you provided to ensure accuracy before submitting the form.
07
Sign and date the form at the bottom to validate it.

Who needs Natrelle Silicone-Filled Breast Implant Device Tracking Form?

01
Patients who have undergone breast augmentation or reconstructive surgery using Natrelle Silicone-Filled Breast Implants.
02
Healthcare providers and surgeons involved in the procedure to track and manage patient records and implant details.
03
Regulatory bodies that require information for safety and compliance purposes.
Fill form : Try Risk Free
Users Most Likely To Recommend - Summer 2025
Grid Leader in Small-Business - Summer 2025
High Performer - Summer 2025
Regional Leader - Summer 2025
Easiest To Do Business With - Summer 2025
Best Meets Requirements- Summer 2025
Rate the form
4.0
Satisfied
20 Votes

People Also Ask about

To submit a claim For coverage eligibility, your surgeon must contact the Allergan Product Surveillance team prior to surgery at 1-800-624-4261 and provide the appropriate documentation. The surgeon is required to return the explanted, disinfected Natrelle® implant(s) within 3 months of the date of explantation.
BIA-ALCL treatment coverage In the event of a BIA-ALCL diagnosis, you are eligible for up to $7,500 out-of-pocket financial assistance toward the removal of the implant(s) and the associated scar tissue (complete capsulectomy). Allergan® will also provide replacement implant(s) at no charge.
Like all implants, Natrelle implants aren't meant to last forever. However, you can expect them to last at least 10 to 20 years.
The specific Allergan implants recalled are: Natrelle Saline-Filled Implants (Styles 163, 168, 363, 468) Natrelle Silicone-Filled Textured Implants (Styles 110, 115, 120, TRL, TRLP, TRM, TRF, TRX, TCL, TCLP, TCM, TCF, TCX, TSL, TSLP, TSM, TSF, TSX)
Standard warranties for implants usually cover two things: the cost of the implant and a predetermined amount of financial assistance for any qualifying revision surgeries (usually due to implant rupture).

For pdfFiller’s FAQs

Below is a list of the most common customer questions. If you can’t find an answer to your question, please don’t hesitate to reach out to us.

The Natrelle Silicone-Filled Breast Implant Device Tracking Form is a document used to track and monitor the use of Natrelle silicone-filled breast implants for safety and regulatory compliance.
Surgeons and healthcare providers who implant Natrelle silicone-filled breast implants are required to file the tracking form.
To fill out the form, healthcare providers must provide specific patient information, details about the implants used, and the date of surgery.
The purpose of the tracking form is to ensure proper monitoring of patients with breast implants and to maintain compliance with safety regulations.
The form must report patient identification details, implant serial numbers, type of procedure, and any complications or follow-up care provided.
Fill out your natrelle silicone-filled breast implant online with pdfFiller!

pdfFiller is an end-to-end solution for managing, creating, and editing documents and forms in the cloud. Save time and hassle by preparing your tax forms online.

Get started now
Form preview

Natrelle Silicone-Filled Breast Implant is not the form you're looking for?Search for another form here.

Related Features

Easily Edit and Add Fillable Fields to PDF online
Easily Edit and Add Objects to PDF online
Easily Edit and Add Signature to PDF online
Easily Edit and Amend PDF online
Easily Edit and Annotate PDF online

Relevant keywords

Allergan Natrelle breast implant device tracking silicone-filled medical form patient information implantation explantation device disposal

Related Forms

Form preview
New membership form.pdf
For people with intellectual, developmental and other life-affecting disabilities. yes! i want to make a
Fill Now
Form preview
2011 nomination form.pdf
Builders association of eastern connecticut save the date friday, december 2, 2011 2011 nomination form
Fill Now
Form preview
Position Description Form (PDF) College: Algonquin College Incumbent's
Position description form (pdf) college: algonquin college incumbent's name: position title: scheduling officer pay band:
Fill Now
Form preview
Registration form Spring 2013 website.pdf
American association of family and consumer sciences/connecticut affiliate spring meeting thursday, may 2, 2013, courtyard
Fill Now
Form preview
Registration form April 2013 website.pdf
American association of family & consumer sciences/ connecticut affiliate afternoon meeting thursday, april 4, 2013,
Fill Now
Form preview
Registration form Februrary 2013 website.pdf
American association of family & consumer sciences/ connecticut affiliate afternoon meeting thursday, february 28, 2013,
Fill Now
Form preview
Registration form Winter 2013 website.pdf
American association of family & consumer sciences/ connecticut affiliate afternoon meeting thursday, january 31, 2013,
Fill Now
If you believe that this page should be taken down, please follow our DMCA take down process here .
This form may include fields for payment information. Data entered in these fields is not covered by PCI DSS compliance.