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merck patient assistance form

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Com Please complete all information both sides. Incomplete forms will be returned. For additional information on this and other Merck Patient Assistance Programs please visit merckhelps. PO Box 690 Horsham PA 19044-9979 For inquiries please call 800-727-5400 MERCK PATIENT ASSISTANCE PROGRAM ENROLLMENT FORM PATIENT MUST COMPLETE THIS SIDE. Use a Black or Blue Pen Yes No US Resident SECTION 1 COMPLETE THE PATIENT INFORMATION BELOW. PLEASE PRINT IN LEGIBLE CAPITAL LETTERS Patient s First Name M....
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$80,000: (Not Mandatory) Yes No No F F Family Status: Single or Married D D D D List and describe your current health problem: (Not Mandatory) Yes No Yes E E List the medications you are currently taking (Not Mandatory) (Required) Yes No Yes F F List treatments currently being tried or used: (Not Mandatory) (Required) Yes No Yes B B The full application form (PDF, 1 page) is available from the Merck HMO Call Center at 1-800-745-6232, Mon-Fri 9-5 Central Time. For more information, visit www.merck.org. MEDICARE DIVISION MEDICAL EDUCATION SERVICES - PHYSICIANS P: 741-521-2032 E: Medical Education and Patient Assistance Services D: 741-824-7141 E-mail: F: 741-848-1866 E-mail: For inquiries, please call 741-549-4545 or email them at: MDI D: 741-764-5227 E-mail: BARREL OF TREATMENT D: 561-236-8500 E-mail: FOR INTERNATIONAL MEDICAL TRAINING - CERTAIN DUTIES ARE REQUIRED CERTAIN DUTIES ARE REQUIRED P: 741-553-7011 E: Medical Education and Patient Assistance Services C: 614-955-8800 D: 741-824-7141 E-mail: INJURY INVESTIGATION CERTAIN DUTIES ARE REQUIRED ERIC MEDICAL GROUP, INC. P: 741-824-7440 E: ERIC1@ERIC.COM D: 614-955-7733 E-mail: P: 741-550-9010 E: ERIC4@ERIC.COM D: 614-955-7733 E-mail: UNITED HEALING GROUPS P: 741-545-7788 E: Medical Education and Patient Assistance
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My name is Ben decay×39’m with women for cancer early detection and treatment IN×39’m a co-founder chair of the board I like to walkabout myths and misconceptions like there is the myth for example that cancels a death sentence by the fact that we have all these women survivors who are going beyond the disease through this program is proof enough that therein life beyond cancer then there is the other one that all you know cancer is contagious, and I find that to be quite fallacy because if you think about tithe people with cancer unless somebody tells you IN#39’m a survivor you'll never ever be able to know and what I need is more of hugs and love as opposed to shrugs and stigma we need to demystify that we also need to demystified yellow and that cancer is brought on by witchcraft or that it's curse it's actually probably drawn from the fact that some cancers may run in the family and the risk factors may be such that it#39’s pretty supposed to genetic factors like breast cancer for example, but it's not sort of like curse that has been brought on the family or that somebody is giving them the bad eye people need to talk about these things the misconception that cancer is expensive to treat people need to know that it's about what stagediscordif cancer is caught ending in the early stages the cost of treatment is very minimal sometimes even they do not have to use a body yoga because it was called knee and the recovery is a hundredpercentanswer needs to be a conversation that had everywhere in the churches in the schools in opera settings in government and in policy we need to talk about stand demystified answer so that people stop fearing it that#39’s one thing to tell somebody you have cancer it×39’s another to give them access to treatment early so that then they can become treated fully recover a hundred percent go on to live normal lives that way people see the empowerment element I can beat this wended to stop treating cancer patients Asif they are a different person we need to emphasize that there is life beyond cancer there is life after the diagnosis there is life after the treatment and not start treating them like a chicken sort of bomb somebody who is waiting Jodie the mock modern efficient campaign has been very beneficial to our women because the women we have are cancer survivors and often society looks anthem as dependents but with a mock campaign we're able to get these women empowered financially they becomeself-reliant they become contributors tithe community when these ladies are supported to be able to become income generating members of the society therein an element of self-esteem that comes with it that someone is the longer dependent on others for their livelihood, or they are able to supplement what their spouse can be able to bring to their family I think that's an empowerment strategy that#39’s very, very good for the women because as you know they take care of the family can you imagine how much a woman impacts on...
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