Common Contracts
1 similar Patient Treatment Agreement contracts
Anthem HealthKeepers Plus Hepatitis C Therapy Patient Treatment AgreementPatient Treatment Agreement • December 21st, 2017
Prescriber instructions: Please submit the completed agreement with the initial prior authorization requests. Patient instructions: By reading and signing this agreement, I acknowledge that I have been informed about the requirements of the treatment program and understand what is expected of me. I can refuse to sign this agreement, but treatment will not be started until and unless I sign this agreement.
