Transcription of XELSOURCE Patient Assistance Program Application
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Example: bachelor of science
XELSOURCE Patient Assistance Program Application
1 Phone 1- 84 4-XELJANZ (1-844-935-5269) Fax 1-866-297-3471 2730 S. Edmonds Lane, Suite 300, Lewisville, TX 75067 Patient Declaration By signing below, I affirm that my answers and my proof-of-income documents are complete, true, and accurate to the best of my understand that: Completing this Application form does not guarantee that I will qualify for the Pfizer Patient Assistance Program . Pfizer may verify the accuracy of the information I have provided and may ask for more financial and insurance information. Any medications supplied by the Pfizer Patient Assistance Program shall not be sold, traded, bartered, or transferred.
XELJANZ/XELJANZ XR is a prescription medicine called a Janus kinase (JAK) inhibitor. XELJANZ/XELJANZ XR is used to treat adults with moderately to severely active rheumatoid arthritis in which methotrexate did not work well. XELJANZ/XELJANZ XR is used to treat adults with active psoriatic arthritis in which
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