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Click ‘Get Form’ to open the gammassist enrollment form in the editor.
Begin by filling out the Enrollee Information section. Enter the name, parent/guardian name (if applicable), street address, city, state, zip code, email address, home telephone number, date of birth, and therapy start date.
In the THERAPY section, select your therapy type from options like GAMMAGARD S/D IGIV or POLYGAM S/D IGIV. Provide your average monthly usage for the selected therapy.
Next, complete the DIAGNOSIS section by checking any relevant conditions such as Immunodeficiency Syndromes or B-cell Chronic Lymphocytic Leukemia (CLL). If 'Other' is selected, specify the diagnosis.
Fill in your Health Insurance Information including primary insurance carrier details and policy ID. Ensure all fields are accurately completed.
Provide Physician Information by entering the physician's name and contact details along with any home care company information if applicable.
Review and sign the Enrollee’s Authorization and Certification section to confirm that all provided information is accurate. Date and sign where indicated.
Once completed, save your form and follow instructions to mail or fax it to PAREXEL at the provided address.
Start using our platform today for free to streamline your gammassist enrollment process!
Reference ranges Age/GenderReference rangeUnits Male 4m - 18y 45 U/L Male 18y 61 U/L Female 4m - 18y 18y 36 U/L3 more rows May 11, 2015
Is 200 high for GGT?
GGT (gamma glutamyl transpeptidase) is elevated in those who use alcohol or toxins. Our GST shows up high between 50 and 200 if we are often taking paracetamol or using alcohol a lot. It is often a sign of alcoholism or longer term liver damage, but can be reversed by adopting a alcohol free or toxin free lifestyle.
What is considered extremely high GGT?
What is an alarming level of GGT? A high level of GGT can depend on the laboratory performing the test, but anything over 50 IU/L can indicate liver damage. For some laboratories, this number might be lower. For example, the United Kingdoms NHS suggests that a high level of GGT is over 40 IU/L.
What happens if GGTP is high?
If your liver or bile duct is damaged, GGT may leak into your bloodstream. So high levels of GGT in your blood may be a sign of liver disease or damage to the bile ducts. Bile ducts are tubes that carry bile in and out of the liver.
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