Spravato Enrollment Form. This form is intended only for use by outpatient medical ofices or clinics, excluding emergency. Web have the authorized representative complete and submit the outpatient healthcare setting enrollment form at.
Esketamine/Spravato Revitalist of Knoxville
Web complete this form online at www.spravatorems.com, or complete the paper form and fax to the spravato®. Web have the authorized representative complete and submit the outpatient healthcare setting enrollment form at. Web pharmacy enrollment form instructions: Review the spravato® prescribing information and the spravato® rems. Web patient enrollment form spravatotm is available only through the spravatotm rems, a restricted distribution program. This form is intended only for use by outpatient medical ofices or clinics, excluding emergency.
Web have the authorized representative complete and submit the outpatient healthcare setting enrollment form at. Web patient enrollment form spravatotm is available only through the spravatotm rems, a restricted distribution program. Review the spravato® prescribing information and the spravato® rems. Web complete this form online at www.spravatorems.com, or complete the paper form and fax to the spravato®. This form is intended only for use by outpatient medical ofices or clinics, excluding emergency. Web have the authorized representative complete and submit the outpatient healthcare setting enrollment form at. Web pharmacy enrollment form instructions:
