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  • Dompe Oxervate Patient Enrollment Form 2019

Get Dompe Oxervate Patient Enrollment Form 2019-2025

OXERVATE Patient Enrollment Form INSTRUCTIONS Complete all pages of this form for each new prescription. Please Print. Please FAX completed form to Domp Connect to Care at 1.8884548488, phone 1.8333667387.

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Oxervate (cenegermin) works to treat neurotrophic keratitis by helping the nerves in your eye grow and work properly. Can I use Oxervate (cenegermin) to treat other eye problems, like dry eye? No, Oxervate (cenegermin) must only be used for the treatment of neurotrophic keratitis as instructed by a provider.

Instill one drop of OXERVATE in the affected eye(s), 6 times a day at 2-hour intervals for eight weeks. To report ADVERSE REACTIONS, contact Dompé U.S. Inc. at 1-833-366-7387 or FDA at 1-800-FDA-1088 or .fda.gov/medwatch. Please see full Prescribing Information for OXERVATE.

†In clinical trials, up to 72% of patients achieved complete corneal healing, defined as the absence of staining of the corneal lesion and no persistent staining in the rest of the cornea after 8 weeks of OXERVATE treatment.

Eye discomfort, pain, redness, watery eyes, or temporary blurred vision may occur. If any of these effects last or get worse, tell your doctor or pharmacist promptly. Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects.

The active substance in Oxervate, cenegermin, is a copy of a human growth factor called nerve growth factor. When given as eye drops to patients with neurotrophic keratitis, cenegermin helps restore some of the normal healing processes in the eye and repair damage to the eye's surface associated with the condition.

Oxervate improved corneal sensitivity, vision in stage 1 neurotrophic keratitis.

How do I get OXERVATE? OXERVATE is a prescription medication and you will need to speak with your doctor to determine if it is right for you. If you are prescribed OXERVATE, the Dompé Connect to Care program is here to help you access the medication.

Note: After the vial adapter is connected to the vial, OXERVATE can be stored in the refrigerator between 36°F to 46°F (2°C to 8°C) for up to 12 hours. If needed, the OXERVATE with the connected vial adapter may be stored at room temperature up to 77°F (25°C).

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
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
Content Takedown Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
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:
+1 833 426 79 33
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