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Get Prolastin Enrollment Forms
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How to fill out the Prolastin Enrollment Forms online
Filling out the Prolastin Enrollment Forms online can seem daunting, but with clear guidance, the process can be straightforward. This guide will provide you with step-by-step instructions to help you complete and submit your enrollment efficiently.
Follow the steps to fill out the Prolastin Enrollment Forms online
- Press the ‘Get Form’ button to access the Prolastin Enrollment Forms and open them in your preferred online editor.
- Begin by entering the patient's information, including their full name, Social Security number, date of birth, address, and contact information. Ensure that all details are accurate.
- In the medical information section, select the diagnosis related to Alpha1 Antitrypsin Deficiency or Panacinar Emphysema. Provide the AAT phenotype, FEV1 percentage, serum AAT level, weight, and note any allergies.
- Attach necessary medical documentation, including a history/physical summary, pulmonary function tests, chest x-ray reports, and AAT lab reports.
- In the Prolastin-C prescription section, fill out the required dosage, number of refills, infusion rates, and any premedication needed.
- Provide the physician or office information, including the physician's name, contact details, and NPI number. Ensure that the signature is included along with the date.
- Finally, review all entered information for accuracy. Once confirmed, you can save changes, download a copy, print the form, or share it as needed.
Complete the Prolastin Enrollment Forms online today to ensure efficient processing!
Prolastin is indicated for individuals with Alpha-1 Antitrypsin Deficiency, helping to protect the lungs and liver from damage. This treatment can support lung functions and improve quality of life. For comprehensive guidelines on its use, consult your Prolastin Enrollment Forms and have a conversation with your healthcare team.
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