Forms and Documents
To download multiple files at once, select the checkbox next to each file you would like to download from the list below then click Download Selected. Documents will be downloaded as a .zip file.
Esbriet Access Solutions Enrollment Forms
The Statement of Medical Necessity (SMN) and the Patient Authorization and Notice of Release of Information (PAN) forms are required for enrollment in Esbriet Access Solutions.
GATCF Enrollment Forms
These forms are required to enroll your patient in GATCF.
Prior Authorization Tips and Checklists
Appeals Tips and Checklists
To download multiple files at once, select the checkbox next to each file you would like to download from the list above then click Download Selected. Documents will be downloaded as a .zip file.
Latest Updates
Form:
Statement of Medical Necessity (SMN)
Form:
Patient Authorization and Notice of Release of Information (PAN)