Get And Sign aflibercept Injectable Medication Precertification Request aflibercept Injectable Medication Precertification Reques 2017-2021 Form

If yes please indicate OD right eye OS left eye No Will Eylea be given in conjunction with another vascular endothelial growth factor inhibitor No Will the medication be given in the same eye as Eylea Does the patient have any of the following contraindications to Eylea check all that apply Active intraocular inflammation Ocular infection Periocular infection Hypersensitivity Please identify which diagnosis the patient is being treated for Neovascular wet age related macular degeneration AMD...