Inflectra

Referral Guide

The following guide lists the information we need to ensure a quick, seamless patient referral for an Inflectra infusion treatment. Inflectra is a biosimilar to Remicade.

All referrals must include:

• Order
• Patient Demographics
• Supporting Clinicals (Notes and Labs)

Order Information:

• Provider name
• NPI#
• Address
• Phone/Fax
• Provider signature (or electronically authenticated signature)

Patient Demographics:

• Patient name
• Phone number
• Address
• Insurance information (primary and secondary if applicable)

Supporting Clinicals (Notes and Labs):

• Result of Tuberculosis (TB) skin/ lab testing
• Hepatitis B status & date
• Patients current weight and height
• Clinicals to support one or more of the following:
  • Patient has active moderate to severe Crohn’s disease (CD)
  • Patient has active moderately to severely active Ulcerative Colitis (UC)
  • Patient has Rheumatoid Arthritis (RA)
  • Patient has Psoriatic Arthritis
  • Patient has Ankylosing Spondylitis
  • Patient has Plaque Psoriasis

Ready to make a referral?
Download our referral form.