Dupixent Enrollment Form Dermatology - Forms are available at dupixenthcp.com. • hcp signature is required to ensure a valid prescription. This includes both prescriptions within the enrollment form. Web after you prescribe dupixent, a correctly filled out dupixent myway enrollment form helps ensure patient enrollments are processed without delays. • patient signature is required for enrollment in dupixent myway. Patient name prescriber name npi# section 6. Body weight initial dose subsequent doses 15 to less than 30 kg 600 mg (two 300 mg injections) 300 mg q4w Web dupixent® 300mg/2ml prefilled pen 300mg/2ml prefilled syringe 200mg/1.14ml prefilled syringe adults with atopic dermatitis or prurigo nodularis: 600 mg (two 300 mg injections) followed by 300 mg q2w pediatric patients with atopic dermatitis: Please ensure that you are filling out the correct form that corresponds to the appropriate indication.
Web dupixent® 300mg/2ml prefilled pen 300mg/2ml prefilled syringe 200mg/1.14ml prefilled syringe adults with atopic dermatitis or prurigo nodularis: Forms are available at dupixenthcp.com. • hcp signature is required to ensure a valid prescription. Please ensure that you are filling out the correct form that corresponds to the appropriate indication. Body weight initial dose subsequent doses 15 to less than 30 kg 600 mg (two 300 mg injections) 300 mg q4w This includes both prescriptions within the enrollment form. Web after you prescribe dupixent, a correctly filled out dupixent myway enrollment form helps ensure patient enrollments are processed without delays. • patient signature is required for enrollment in dupixent myway. 600 mg (two 300 mg injections) followed by 300 mg q2w pediatric patients with atopic dermatitis: Web to prevent delays, complete the entire form and fax it to the number above. Complete the quick start section in its entirety. Patient name prescriber name npi# section 6.