PATIENT-PRESCRIBER AGREEMENT FORMPrescriber Agreement • May 24th, 2019
Patient Details GP Details Surname: GP Practice: Forename: GP name: Address: Address: Postcode: Postcode: Email : Tel: NHS No: Fax: DOB: NHS.net email: SEX: Male / Female Blueteq Patient ID.:
This Opioid Patient Prescriber Agreement (PPA) is designed to:Prescriber Agreement • February 7th, 2017
Create an open conversation between the patient and the prescriber about the benefits, risks, and limitations of opioid medicines
This Opioid Patient Prescriber Agreement (PPA) is designed to:Prescriber Agreement • May 15th, 2019
• Create an open conversation between the patient and the prescriber about the benefits, risks, and limitations of opioid medicines
PRESCRIBER AGREEMENT FORMPrescriber Agreement • January 16th, 2024
Mifeprex* (Mifepristone) Tablets, 200 mg, is indicated, in a regimen with misoprostol, for the medical termination of intrauterine pregnancy through 70 days gestation. Please see Prescribing Information and Medication Guide for complete safety information.
PRESCRIBER AGREEMENT FORMPrescriber Agreement • January 3rd, 2023
Mifeprex* (Mifepristone) Tablets, 200 mg, is indicated, in a regimen with misoprostol, for the medical termination of intrauterine pregnancy through 70 days gestation. Please see Prescribing Information and Medication Guide for complete safety information.
PRESCRIBER AGREEMENT FORMPrescriber Agreement • February 1st, 2023
Mifeprex* (Mifepristone) Tablets, 200 mg, is indicated, in a regimen with misoprostol, for the medical termination of intrauterine pregnancy through 70 days gestation. Please see Prescribing Information and Medication Guide for complete safety information.
