North Texas Infectious Disease Consultants

		• Actemra Enrollment Form • Albumin Enrollment Form • Aralast Enrollment Form • Aranesp Intake Form • Boniva Enrollment Form • Cidofovir Enrollment Form • Dermatology Patient Information Form • IVIG Enrollment Form • Orencia Enrollment Form • Prolastin Enrollment Form • Prolia Enrollment Form • Reclast Intake Form • Remicade Patient Information Form • Remicade Enrollment Form • Rituxan Enrollment Form • Stelara Patient Information Form • Stelara Enrollment Form • Welcome To North Texas Infusion Letter • Xolair Enrollment Form Fax completed from to (214) 887-0436. Insurance / Clearance Questions call (214) 276-5642 or mike.ellis@ntisp.org. For Pharmacy / Clinical questions call (214) 276-5623. Include following: Patient’s insurance cards (front and back), lab work, letter of medical necessity, Pharmacy Benefit Card and any other documentation supporting the use of the Specialty Drug.