Бланки заказа назначенного препарата
To begin the referral process, download the correct prescriber order form by therapy and product name in the list below. Then, fill in the required prescription and fax it to us at your local Care Management Center. All Option Care Health pharmacies are able to accept electronic prescriptions (e-prescribing). Click here to find the location closest to you.
Prescriptions must be sent from licensed prescribers, accompanied by the patient’s insurance information and in accordance with your state prescribing laws.
We are committed to providing extraordinary care for your patients.
Download
Download
Download
Download the PDF(s) you need from the list below.
Fill, Print & Sign
Complete the form(s) online or by hand, print the completed form and sign the prescription.
Fax Signed Forms
Fax your signed form(s) to the patient’s nearest Option Care Health location
- Противоинфекционная терапия
- Нутритивная поддержка
- Хронические воспалительные процессы
- Иммуноглобулин
- Неврологические расстройства
- Нарушение свертываемости крови
- Женское здоровье
- Сердечная недостаточность
- Специализированная терапия
-
- Ингибитор альфа-1 протеиназы (Aralast® NP, Glassia®, Zemaira®)
- Berinert® (C1 esterase inhibitor)
- Blincyto® (blinatumomab)
- Cabenuva® (cabotegravir-rilpivirine)
- Cinryze® (ингибитор С1-эстеразы)
- Бланк заказа назначенного препарата для проведения процедуры инфузионной терапии на дому
- Kalbitor® (ecallantide)
- Keytruda® (Pembrolizumab)
- Krystexxa® (пеглотиказа)
- Opdivo® (nivolumab)
- Anaphylaxis Kit
- Tepezza® (teprotumumab-trbw)
- Trogarzo® (ibalizumab)
- Ultomiris® (ravulizumab)
- Yervoy® (ipilimumab)
If your therapy is not included above, consider electronically prescribing the medication to us.