Download BAXFENDY Resources for your Patients

Find the right resources to assist your BAXFENDY patients

BAXFENDY Intake Form

BAXFENDY Intake Form

A multi-page intake form to capture necessary patient, provider, and clinical information to start a request for support.

BAXFENDY Patient Authorization Form

BAXFENDY Patient Authorization Form

Ensure your patients complete and sign the BAXFENDY Patient Authorization Form so Access 360 can provide select services.

Sample Letter of Medical Necessity

Sample Letter of Medical Necessity

This template can be used by a healthcare provider to respond to a patient’s insurance company requesting a letter of medical necessity for prescribing an AstraZeneca medicine.

BAXFENDY Sample Letter of Appeal

BAXFENDY Sample Letter of Appeal

This template can be used by a healthcare provider to appeal a denial of access to an AstraZeneca medicine.