Forms and Documents
Here you can download the form you need to enroll in Genentech BioOncology Access Solutions for TECENTRIQ 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 enroll in Genentech BioOncology Access Solutions, you need to sign a form called the Patient Authorization and Notice of Release of Information or PAN form. You can find this form below.
The Statement of Medical Necessity, or SMN form, is a form filled out and submitted by your doctor after he or she prescribes a Genentech product. You do not have to fill out any information on this form.
Questions and Considerations to Ask Your Doctor’s Office
This information packet contains a copy of the PAN form and a list of questions you might have that someone at your doctor's office might be able to answer after you have been prescribed a Genentech product.