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Helpful resources and downloadable assets to support your practice and your patients
Patient Enrollment Form
Download the form, complete it with your patient, including HCP and patient signatures, and submit by fax or email. Bookmark this page for next time!
DocuSign® eSignature Patient Enrollment Form
Complete the form and send to your patient via email to sign electronically via DocuSign®.
Treatment Initiation Resources
Patient Enrollment Form Checklist
Important checklist detailing steps to enroll, educate, and connect TEPEZZA patients with PALs for successful treatment.
TEPEZZA At Your Practice
A guide to clinical, access, and reimbursement considerations for TEPEZZA.
Payor Access Resources
Clinical Documentation Guide
A guide to documenting TED symptomatology with a focus on capturing key clinical criteria, such as Clinical Activity Score (CAS).
Clinical Documentation Tearpad
A form that outlines the CAS that is used to evaluate the inflammatory signs and symptoms of TED.
Letter of Medical Necessity Template
A customizable template for a letter of medical necessity to support PA for TEPEZZA.
Payor Appeal Letter Template
A customizable appeals template for patient cases that were denied PA.
Billing and Coding Resources
Product Fact Sheet
Product information, including NDC, packaging, storage, handling, and authorized distributor list.
Billing and Coding Guide
A guide to billing procedures, necessary codes, and reimbursement with J-code.
Infusion Resources
Infusion Manual
A detailed guide to preparing, administering, and infusing TEPEZZA.
Infusion Administration Video
Key steps required for reconstitution, dilution, and administration of TEPEZZA.
Patient Education Resources
Getting Started on TEPEZZA Patient Brochure
A brochure to guide your patients through the initial steps of getting started on TEPEZZA.
Getting Started on TEPEZZA Video
A video to help your patients understand how to get started on TEPEZZA.
TEPEZZA Insurance Approval Guide
A brochure to guide your patients through insurance coverage and approval of TEPEZZA.
TEPEZZA Pre-Infusion Reminder List
A list that helps your patients prepare for TEPEZZA infusions.
TEPEZZA Post-Infusion Reminder List
A list that helps your patients stay on track after each TEPEZZA infusion.
Patient Enrollment Form Checklist
Important checklist detailing steps to enroll, educate, and connect TEPEZZA patients with PALs for successful treatment.
TEPEZZA At Your Practice
A guide to clinical, access, and reimbursement considerations for TEPEZZA.
Clinical Documentation Guide
A guide to documenting TED symptomatology with a focus on capturing key clinical criteria, such as Clinical Activity Score (CAS).
Clinical Documentation Tearpad
A form that outlines the CAS that is used to evaluate the inflammatory signs and symptoms of TED.
Letter of Medical Necessity Template
A customizable template for a letter of medical necessity to support PA for TEPEZZA.
Payor Appeal Letter Template
A customizable appeals template for patient cases that were denied PA.
Product Fact Sheet
Product information, including NDC, packaging, storage, handling, and authorized distributor list.
Billing and Coding Guide
A guide to billing procedures, necessary codes, and reimbursement with J-code.
Infusion Manual
A detailed guide to preparing, administering, and infusing TEPEZZA.
Infusion Administration Video
Key steps required for reconstitution, dilution, and administration of TEPEZZA.
Getting Started on TEPEZZA Patient Brochure
A brochure to guide your patients through the initial steps of getting started on TEPEZZA.
Getting Started on TEPEZZA Video
A video to help your patients understand how to get started on TEPEZZA.
TEPEZZA Insurance Approval Guide
A brochure to guide your patients through insurance coverage and approval of TEPEZZA.
TEPEZZA Pre-Infusion Reminder List
A list that helps your patients prepare for TEPEZZA infusions.
TEPEZZA Post-Infusion Reminder List
A list that helps your patients stay on track after each TEPEZZA infusion.
