Access 360 General Patient Authorization Form (PAF)

Find the right resources to assist your FLUMIST QUADRIVALENT patients

Access 360 General Patient Authorization Form (PAF)

Access 360 General Patient Authorization Form (PAF)

This brief form, once completed, gives Access 360 the ability to provide select services to you. Available in English and Spanish. The Access 360 General Patient Authorization Form must be signed for you to utilize Access 360 support.

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Click here to fill out the form online.

Access 360 Support Request Form

Access 360 Support Request Form

Fill this form out to receive assistance from Access 360 for your FLUMIST QUADRIVALENT prescription. The Access 360 General Patient Authorization Form must be signed for you to utilize Access 360 support.

FLUMIST QUADRIVALENT Coding Resource

FLUMIST QUADRIVALENT Coding Resource

This resource provides specific codes related to diagnosing and billing for FLUMIST QUADRIVALENT.

Sample Letter of Appeal

Sample Letter of Appeal

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