Stelara enrollment form 2025

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The document is a Prescription Information and StelaraSupport™ Enrollment Form for the medication STELARA® (ustekinumab). It includes sections for patient and prescriber information, insurance details, prior medications, clinical information, patient authorization, prescription details, and enrollment in extended services. The form facilitates the process of obtaining insurance coverage and support services related to STELARA®, ensuring that patients can access necessary treatment while complying with privacy regulations.

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