HUMIRA is a prescription medicine used: • To reduce the signs and symptoms of: – Psoriatic arthritis (PsA) in adults. HUMIRA can be used alone.

Complete the enrollment & prescription form on page 5. • Confirm you will abide by the terms and conditions and that the prescription is accurate by checking ...

Enrollment form for HUMIRA. Please fax the completed form to 1-866-270-1727. For any questions, or to register by phone, please call 1-866-848-6472. © AbbVie ...

Print and complete the enrollment form on page 5 and 6. Provide your consent for eligibility determination by checking the boxes in Section 5 and confirm your ...

HUMIRA Complete offers information, support, and resources designed around you and your child. 1. Please see Uses and Important Safety Information on page 2.

Prescription & Enrollment Form: Crohn's Disease—Humira and Biosimilars. Fax completed form to 888.302.1028. Patient's first name. Last name. Middle initial.

The health care professional (HCP) and the patient or legally authorized person should fill out this form completely before leaving the office. Sections in PLUM ...

Prescription & Enrollment Form: Psoriasis—Humira and Biosimilars. Fax completed form to 888.302.1028. Patient's first name. Last name. Middle initial. Date of ...

Sign up for HUMIRA Complete offering access to Nurse Ambassadors, injection training, cost savings, support, and more. See full Safety & Prescribing Info.

View the Enrollment Form for HUMIRA Assistance Program in our extensive collection of PDFs and resources ... Upload your HUMIRA enrollment PDF into PrintFriendly.