Adempas REMS Patient Enrollment and Consent Form

Adempas REMS Patient Enrollment and Consent Form To report any adverse events, product technical complaints, medication errors or pregnancies associated with the use of Adempas, contact: Bayer at 1-888-842-2937, or send the information to DrugSafety.GPV.US@bayer.com. OR 22Nov2019 Therapy Status: Add-on therapy Transition from other therapy

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Adempas REMS Patient Enrollment and Consent …

www.adempasrems.com

Phone: 1-855-ADEMPAS 1-855-23-362 www.adempasREMS.com Fax: 1-855-662-5200 0OCT2016 REQUIRED FOR ALL FEMALE PATIENTS Access this form online at www.adempasREMS.com, or fax this form to the Adempas Program at 1-855-662-5200

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