Resource List


Resource Path: /content/dam/gene/accesssolutions/pdfs/prescriber-form/LUCENTIS-Prescriber-Service_Form.pdf

Video Modal Path:

Title: Prescriber Service Form

Description: The Prescriber Service Form replaces the SMN. It includes patient, insurance, and prescription information used when LUCENTIS Access Solutions contacts a patient's health insurance plan to determine his or her coverage.

Tags:

Thumbnail:

Resource Triggers Registration Modal: false


Resource Path: /content/dam/gene/accesssolutions/pdfs/patient-consent-form/Genentech-Access-Solutions-Patient-Consent_Form.pdf

Video Modal Path:

Title: Patient Consent Form

Description: The Patient Consent Form replaces the PAN. This form is signed and dated by your patient giving written permission for LUCENTIS Access Solutions to discuss his or her health information with you and the patient's health insurance plan.

Tags:

Thumbnail:

Resource Triggers Registration Modal: false


Resource Path: /content/dam/gene/accesssolutions/pdfs/patient-consent-form/Genentech-Access-Solutions-Patient-Consent-Form_Spanish.pdf

Video Modal Path:

Title: Patient Consent Form – Spanish Translation

Description: A version of the Patient Consent Form for your Spanish-speaking patients.

Tags:

Thumbnail:

Resource Triggers Registration Modal: false