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HIGHLIGHTS OF PRESCRIBING INFORMATION Iron ... - …
1 . HIGHLIGHTS OF PRESCRIBING INFORMATION . These highlights do not include all the information needed to use AURYXIA ® safely and effectively. See full prescribing information for
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Enrollment Form for AURYXIA (ferric citrate)
www.auryxia.comSIGNATURE OF PATIENT OR AUTHORIZED PATIENT REPRESENTATIVE*: DATE: I already know my patient’s out-of-pocket cost and am requesting Patient Assistance Program evaluation. PLEASE SEND AN EMAIL TO MY PATIENT TO COLLECT ELECTRONIC SIGNATURES Enrollment Form for AURYXIA® (ferric citrate)