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FluMist Download and Enrollment Forms

Find the right resources to assist your FLUMIST patients

FLUMIST Enrollment Forms

FLUMIST Enrollment Form

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

FluMist Coding Resource

FLUMIST Coding Resource

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

FluMist 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.