Forms and Documents

Here you can download the form you need to enroll in Genentech Rheumatology Access Solutions and other important information. Please remember, your doctor also needs to fill out a form to enroll you.

Start Enrollment With the PAN Form

To get started, fill out a form called the PAN. You can find this form below.


Your doctor also has to fill out a form called the SMN. Once we have both these forms, we can begin working with you and your doctor’s office. You do not have to fill out any information on this form.

Questions and Considerations to Ask Your Doctor’s Office

This information packet includes:

  • A copy of the PAN form
  • A list of questions you might have

Someone at your doctor's office might be able to answer these questions after you have been prescribed Rituxan.

PAN=Patient Authorization and Notice of Request for Transmission of Health Information to Genentech Access Solutions and Genentech® Access to Care Foundation.

SMN=Statement of Medical Necessity.