Spravato Rems Enrollment Form

Spravato Rems Enrollment Form - Step 2 Together with your healthcare provider complete and sign the SPRAVATO REMS Patient Enrollment Form Your healthcare provider will fill out most of the form for you and will send the form to SPRAVATO REMS Step 3 Ask your healthcare provider any questions you have about taking SPRAVATO and about the SPRAVATO REMS

Spravato must be administered in health care settings certified in the Spravato REMS Program under the direct supervision of a health care provider to patients enrolled in the program Recommended dosage for Spravato INDUCTION PHASE On day 1 administer 56 mg intranasally

Spravato Rems Enrollment Form

Spravato Rems Enrollment Form

Enrollment SPRAVATO ® Indication SPRAVATO ® is a non-competitive N-methyl D-aspartate (NMDA) receptor antagonist indicated, in conjunction with oral antidepressant, for the treatment of: Treatment-resistant depression (TRD) in adults. Depressive symptoms in adults with major depressive disorder (MDD) with acute suicidal ideation or behavior.

Pharmacy Enrollment Form INSTRUCTIONS Review the SPRAVATO Prescribing Information and the SPRAVATO REMS Program Overview Complete this form online at SPRAVATOrems or complete the paper form and fax to the SPRAVATO REMS at 1 877 778 0091

Span Class Result Type

INSTRUCTIONS Review the SPRAVATO Prescribing Information and the SPRAVATO REMS Program Overview Complete this form online at SPRAVATOrems or complete the paper form and fax to the SPRAVATO REMS at 1 877 778 0091 This form is intended only for Outpatient Medical Ofices and Clinics

Fillable Online SPRAVATO REMS Patient Enrollment Form Fax Email Print PdfFiller

Getting Started SPRAVATO withMe is limited to education for patients about SPRAVATO its administration and or their disease and is not intended to provide medical advice replace a treatment plan from the patient s doctor or nurse or provide case management services

SPRAVATO REMS Risk Evaluation And Mitigation Strategy

How does my Healthcare Setting become certified in the SPRAVATO REMS Step 1 Designate an Authorized Representative to oversee implementation and compliance with the REMS requirements Step 2 Review the following materials SPRAVATO REMS Fact Sheet SPRAVATO Medication Guide SPRAVATO Prescribing Information SPRAVATO Instructions for Use

New Spravato FDA Approval Opens The Door To New Patients Says Sandhya Prashad M D Sandhya

Have the Authorized Representative complete and submit the Outpatient Healthcare Setting Enrollment Form at SPRAVATOrems or complete the paper form and fax to the SPRAVATO REMS at 1 877 778 0091

Your healthcare provider will help you complete this form and provide you with a copy. Prescribers and patients: Please complete this form online at SPRAVATOrems.com or, once completed, fax it to the REMS at 1-877-778-0091 * Indicates Required Field Relevant Clinical Information

SPRAVATO REMS Risk Evaluation And Mitigation Strategy

This Access Coding and Reimbursement Guide contains important information about SPRAVATO including its uses and Important Safety Information the Risk Evaluation Mitigation Strategy REMS information about how to identify authorized distributors and guidance on access and reimbursement

Spravato Rems Enrollment Form

Have the Authorized Representative complete and submit the Outpatient Healthcare Setting Enrollment Form at SPRAVATOrems or complete the paper form and fax to the SPRAVATO REMS at 1 877 778 0091

Spravato must be administered in health care settings certified in the Spravato REMS Program under the direct supervision of a health care provider to patients enrolled in the program Recommended dosage for Spravato INDUCTION PHASE On day 1 administer 56 mg intranasally

EsKetamine Johnson City SPRAVATO FDA Approved Treatment