TOUCH Prescribing Program Overview for TYSABRI
This document provides detailed information about the TOUCH Prescribing Program for TYSABRI, including its purpose, enrollment requirements, and how to manage patient treatment. It outlines the indications for use of TYSABRI in Multiple Sclerosis and Crohn's Disease, as well as important safety information. If you are a prescriber, infusion site, or patient, this document is crucial for understanding the proper use and risks associated with TYSABRI.
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How do I fill this out?
To fill out this form, start by reviewing the instructions carefully. Ensure that you gather all necessary patient information and documentation before proceeding. Once you have completed the form, review it for accuracy before submission.
How to fill out the TOUCH Prescribing Program Overview for TYSABRI?
1
Read the instructions thoroughly.
2
Gather all required patient information.
3
Fill out the form with accurate details.
4
Review the completed form for errors.
5
Submit the form according to the instructions.
Who needs the TOUCH Prescribing Program Overview for TYSABRI?
1
Healthcare providers prescribing TYSABRI to understand its associated risks.
2
Infusion centers needing authorization to administer TYSABRI.
3
Patients prescribed TYSABRI for Multiple Sclerosis or Crohn's Disease.
4
Pharmacies dispensing TYSABRI requiring compliance with the TOUCH program.
5
Insurance companies verifying the necessity and compliance of TYSABRI prescriptions.
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What are the instructions for submitting this form?
To submit the TOUCH Prescribing Program form, ensure you have completely filled out all necessary fields, including patient and prescriber information. You can fax completed forms to Biogen at 1-800-840-1278 or submit it directly to their representative. For further assistance, contact the Biogen representative or the provided helpline at 1-800-456-2255.
What are the important dates for this form in 2024 and 2025?
Review the TOUCH Prescribing Program for specific enrollment and compliance deadlines in 2024 and 2025. Stay updated on changes that may affect the prescription process. Important dates ensure that providers and patients maintain access to necessary treatments without interruption.
What is the purpose of this form?
The purpose of this form is to ensure that all healthcare providers, infusion centers, and pharmacies are compliant with the necessary requirements to safely prescribe and use TYSABRI. It serves as a vital tool for managing patient health and safety during treatment. Additionally, this form helps track patients who are receiving TYSABRI to monitor for any potential adverse effects.
Tell me about this form and its components and fields line-by-line.
- 1. Patient Name: Full name of the patient receiving treatment.
- 2. Diagnosis: Medical condition for which TYSABRI is prescribed.
- 3. Prescriber Information: Details regarding the healthcare provider prescribing TYSABRI.
- 4. Infusion Site: Location where the infusion will take place.
- 5. Date of Treatment: Scheduled date for the patient's treatment.
What happens if I fail to submit this form?
If the form is not submitted, patients may face delays in receiving TYSABRI, and prescribers may lose their authorization to prescribe the medication. Compliance with the TOUCH program requirements is critical for safety and monitoring purposes.
- Patient Safety: Lack of submission may jeopardize patient monitoring and safety protocols.
- Authorization Loss: Failure to submit can result in the loss of the ability to prescribe or dispense TYSABRI.
- Treatment Delays: Incomplete forms can lead to delays in treatment, impacting patient health.
How do I know when to use this form?
- 1. Initial Evaluation: Use this form for the initial assessment of patients suited for TYSABRI.
- 2. Ongoing Treatment: This form assists in documenting ongoing patient treatment progress.
- 3. Compliance Monitoring: It helps ensure that all compliance measures are met throughout treatment.
Frequently Asked Questions
What is the PURPOSE of the TOUCH Prescribing Program?
The TOUCH Prescribing Program aims to provide necessary information regarding the prescription of TYSABRI while ensuring patient safety.
WHO needs to fill out this form?
Healthcare providers, infusion sites, pharmacies, and patients involved in TYSABRI treatment need to fill out this form.
How can I EDIT this PDF?
You can edit the PDF using PrintFriendly's editing tools which allow for easy modifications and text input.
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Yes, you can easily sign the PDF by creating or uploading your signature within the PrintFriendly platform.
How do I SHARE this document?
The document can be shared via email or social media using the share function on PrintFriendly.
Are there specific DATES important for this form?
Yes, you should review the document for specific important dates related to enrollment and compliance.
What happens if I fail to submit this form?
Failing to submit the form may result in the inability to prescribe or dispense TYSABRI.
WHEN should I use this form?
Use this form when initiating treatment with TYSABRI or when needing to document patient safety and compliance.
What are the INSTRUCTIONS for submitting this form?
Follow the step-by-step instructions within the document for proper submission via fax or mail.
What DISTINCTIONS should I note about the TOUCH program?
The TOUCH program provides crucial guidelines for the safe administration of TYSABRI, including risk assessments and patient monitoring.
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