![]() Partners, who are performing the services set forth in this Authorization. My health information to only release it to Amgen employees, as well as to its I understand that by signing this form, I authorize my health care providers or Information to contact me with communications about Amgen products which have beenĮxample medication reminder programs) and other patient support services.Įxpiration, Right to Obtain a Copy, and Right to Cancel Remuneration from Amgen in exchange for disclosing my personal health information That certain of my health care providers (such as pharmacies and specialty Themselves, as necessary, but only for the purposes stated above in this I authorize my health care providers to disclose my personal health information to ![]() Limits or restrictions covered by my health care plan policy, and/or my adherence to Information from or about my medical history and general health, my health care plan Possession of or derived from a health care provider, health care plan, pharmacy,Ĭompany, laboratory and/or their contractor (“health care provider”). Personal health information may include any information, in electronic or physical In order for Amgen to provide me with the services and/or programs described above,Ĭollect and use my personal information, including my personal health information. To improve, develop, and evaluate products, services, materials, and programs.Services, and/or my condition or treatment and/or To provide me with informational and promotional materials relating to.Health information that may be useful for my care To contact, with my permission, my doctor and the rest of my health care team.To operate, administer, enroll me in, and/or continue my participation in theĬo-Pay Program or any other Amgen-affiliated patient support services andĬondition or treatment (for example, Co-Pay card programs, reimbursementĬoverage verification, nurse educator services, adherence program, and disease.Personal information, including my personal health information, for the following I authorize Amgen and its contractors and business partners (“Amgen”) to use and/or The Amgen Privacy Statement can be found at. To obtain a copy of this authorization or to cancel at any time, IĬan contact Amgen by calling 1-844-REPATHA (1-84) or by writing to Amgen, PO Box 781046, I do not have to sign this authorization, and this authorization in no way affects my Informational and marketing communications related to my condition and treatment are optional andįree services. I further understand that the Repatha ® information program and additional The contact information provided in this form to enroll me in, operate, and administer the Repatha ® information program. I understand and consent to Amgen contacting me using That Amgen contact me by mail and/or email. I understand that the operation and administration of certain services and/or programs may require ![]() Informational and promotional materials relating to Amgen products and services and/or myĬondition or treatment and/or to improve, develop, and evaluate products, services, materials,Īnd programs related to my condition or treatment. To operate, administer, enroll me in, and/or continue my participation in Amgen’s Repatha ® information program and related activities to provide me with Personal information, including my personal health information, for the following purposes only: I authorize Amgen and its contractors and business partners (“Amgen”) to use and/or disclose my Uses and Disclosure of Personal Information ![]()
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