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Moderate to severe persistent asthma in people 6 years of age and older whose. Web 4 prescribing information medication strength/formulation directions quantity/refills xolair® (omalizumab) asthma(dose is dependent on weight and ige. Once completed, fax to the number indicated on the form. Please note you must sign the. Web xolair is indicated for the treatment of adults and adolescents 12 years.
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Read “authorization to use and disclose personal information” on page 2. Web patient enrollment and consent form for patients prescribed prxolair® for chronic idiopathic urticaria (ciu), all sections must be completely filled out (please print). Sign and date page 3. This includes an open enrollment form and planned entry form. Web xolair enrollment form date:
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