Glaxo Smith Kline
• Systemic Lupus Erythematosus (IV)
ㅤㅤㅤ• 10 mg/kg at 2-week intervals for the first 3 doses and at 4-week intervals thereafter
ㅤㅤㅤ• No ancillary tests needed
1 – Please open authorization forms (above). Fill out the forms on your computer, save and print.
2 – Open Physician Orders for the office of your choice (above). Save to your computer, print and fill out.
3 – Fax the following to Pacific Infusion Center (310) 297-9222:
ㅤ• Completed and signed forms/order
ㅤ• Copy of the patient’s insurance card(s)
ㅤ• OV notes
ㅤ• Tried and failed medications
ㅤ• Drug Enrollment Forms
4 – After the patient’s infusion appointment, our nurses will fax a copy of the infusion notes to your office.