Sublocade™ for the Treatment of Opioid Use Disorder Drug Development
Sublocade Patient Enrollment Form. Download and print the enrollment form. Flintake@curanthealth.com fax sublocade rx to:
Sublocade™ for the Treatment of Opioid Use Disorder Drug Development
See safety info, prescribing info & boxed warning. Open pdf, opens in a. Access information about this chronic disease and how sublocade may help. Web how can insupport help? Web fax sublocade enrollment form to: Web for a person on sublocade, it is important to instruct a family member or friend to, in the event of an emergency, inform the medical staff that the person is physically dependent. To enroll, please complete and send. Support your patients with tools and downloadable resources for sublocade. The insupport copay assistance program is not insurance. Ad learn about sublocade on the official product site.
Web prescription & enrollment form: To enroll, please complete and send. Web injection ciii enrollment form (please use black ink) prescriber’s name state license phone city, state, zip contact person phone fax dea npi xdea group/hospital. Web to submit your referral/prescription: Ad download a patient enrollment form. Web • required sections of the patient enrollment form: Web initiate a benefit investigation by filling out the patient enrollment form and submit to insupport® via fax, along with the prescription; Web for a person on sublocade, it is important to instruct a family member or friend to, in the event of an emergency, inform the medical staff that the person is physically dependent. Access information about this chronic disease and how sublocade may help. Ad learn about sublocade on the official product site. Patient’s first name last name middle initial.
