Forms and Documents

Genentech Access Solutions for Rituxan® (rituximab) for Granulomatosis with Polyangiitis (GPA) and Microscopic Polyangiitis (MPA) 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 Genentech Access Solutions for Rituxan for GPA and MPA.

GATCF Enrollment Forms

These forms are required to enroll your patient in GATCF.
 

Prior Authorization Tips and Checklists

Appeals Tips and Checklists