Resources
Resources for your Practice and Patient Support
A range of PALFORZIA educational materials is available for your practice and patients.
Prescribers, healthcare settings, and patients must be enrolled in the PALFORZIA REMS Program before a patient can be prescribed PALFORZIA and enrolled in PALFORZIA Pathway.
Practice resources
- Access the PortalAccess the Portal/>
PALFORZIA QuickEnroll Electronic Patient Prescription Enrollment
- Download PDFDownload PDF/>
Prescription and Enrollment Form
- Download PDFDownload PDF/>
Prescription and Enrollment Form (Spanish)
- Access the PortalAccess the Portal/>
Palforzia Up-dose Shipment Request Portal
- Download PDFDownload PDF/>
Palforzia Up-dose Shipment Request Fax Form
- Download PDFDownload PDF/>
Palforzia Toddler Indication Brochure
- Download PDFDownload PDF/>
Palforzia HUB & SP Process Resource
- Download PDFDownload PDF/>
Practice Implementation Checklist
- Download PDFDownload PDF/>
Practice Readiness Flashcard
- Download PDFDownload PDF/>
Coding and Billing Flashcard
- Download PDFDownload PDF/>
Packaging and Ordering Overview Brochure
- Download PDFDownload PDF/>
PALFORZIA REMS Program Overview Brochure
- Download PDFDownload PDF/>
Sample Letter of Medical Necessity
Educational support resources
- Download PDF
Dose Administration Overview Brochure
- Download PDF
Treatment Pathway Brochure
- Download PDF
Assessing Allergic Reactions Brochure
- Download PDF
Dose Modifications and Missed Dose Management Brochure
- Download PDF
Dosing Overview Brochure
- Download PDF
Patient Dosing History Form
