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  • Patient Informationinformed Consent For All Patients - Ipledge

Get Patient Informationinformed Consent For All Patients - Ipledge

IPLEDGECommitted to Pregnancy Prevention P.O. Box 29094 Phoenix, AZ 85038 Patient Information/Informed Consent (for all patients): To be completed by patient (and parent or guardian if patient is.

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must only be prescribed by prescribers who are registered and activated with the iPLEDGE program. must only be dispensed by a pharmacy registered and activated with iPLEDGE, and must only be dispensed to patients who are registered and meet all the requirements of iPLEDGE (see PRECAUTIONS).

Therefore, we suggest that parenteral progestogen-only contraceptives (injectable preparations, implants, intrauterine system or device) be adopted as a standard approach to contraception for female patients considered for therapy.

The iPLEDGE Program requires registration of all wholesalers distributing , all healthcare professionals prescribing , all pharmacies dispensing , and all male and female patients prescribed .

The iPLEDGE Program is a single, shared (includes multiple manufacturers) Risk Evaluation and Mitigation Strategy (REMS) program with requirements for prescribers, pharmacies, patients, and wholesalers. The iPLEDGE Program also includes a pregnancy registry for patients who get pregnant.

Registration and activation is a two-step process. Registration - Prescribers may obtain a registration form online from the website's homepage or by calling 1-866-495-0654, for assistance with the online registration form. They are instructed to sign and fax the completed form to the iPLEDGE Program 1-866-495-0660.

must only be prescribed by prescribers who are registered and activated with the iPLEDGE program. must only be dispensed by a pharmacy registered and activated with iPLEDGE, and must only be dispensed to patients who are registered and meet all the requirements of iPLEDGE.

The iPLEDGE program is a computer-based risk management system that uses verifiable, trackable links between prescriber, patient, pharmacy, and wholesaler to control prescribing, using, dispensing, and distribution of .

The purpose of the iPLEDGE program is to prevent pregnancy in people taking . Taking while pregnant can cause birth defects. It also increases your risk for complications, such as miscarriage or preterm birth.

The iPLEDGE Program requires registration of all wholesalers distributing , all healthcare professionals prescribing , all pharmacies dispensing , and all male and female patients prescribed .

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© Copyright 1997-2025
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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232