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0000051546 00000 n 0000026154 00000 n 0000087803 00000 n 0000014130 00000 n Available for PC, iOS and Android. Today, Pfizer RxPathways ® connects eligible U.S. patients to a range of Pfizer assistance programs that provide insurance support, co-pay help, and medicines for free or at a savings.. 0000008249 00000 n 0000002510 00000 n
0000003918 00000 n information about me with the Pfizer Patient Assistance Program, Pfizer Inc., and the Pfizer Patient Assistance Foundation Inc. Signature of Patient X Date: 3 Group D [4 of 6 ] The Pfizer Patient Assistance Program is a joint program of Pfizer Inc. and the Pfizer Patient Assistance FoundationTM. Fill out, securely sign, print or email your Pfizer Patient Assistance Program - Pfizer RxPathways instantly with SignNow. xref 0000019812 00000 n The Pfizer Patient Assistance Program is a joint program of Pfizer Inc. and the Pfizer Patient Assistance FoundationTM. < 0000012906 00000 n 0000002306 00000 n
0000113724 00000 n 0000077451 00000 n With the introduction of Pfizer PAP Connect, we’ve taken the paper and the phone calls out of the process and created a simple online tool that enables patients and prescribers to: endstream endobj 957 0 obj <>/Filter/FlateDecode/Index[70 816]/Length 49/Size 886/Type/XRef/W[1 1 1]>>stream 0000012362 00000 n 0000108548 00000 n 0000044803 00000 n 0000113683 00000 n 0000023786 00000 n • Completing this enrollment form does not guarantee that I will qualify for the Pfizer Patient Assistance Program. 0000103331 00000 n Visit www.PfizerRxPathways.com. 0000008888 00000 n 0000072316 00000 n
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0000134387 00000 n 0000098196 00000 n The Pfizer Patient Assistance Foundation is a separate legal entity from Pfizer Inc. with distinct legal restrictions. 0000021526 00000 n Patient Savings Offers. 1110 76 0000118859 00000 n Ä¡`i>^Î}Œ9¸œÂC:›r>ÈLdbçLğ] éxœcó„âVñÇk1°¸°``NÛ¹Àü _ÏwæË%ï¦&^�cmèd,àLPm˜Æ” oPß´“ÁHÏ�ëĞrÆ;‘²Œ�0�=PÎp€™A¼¡œáˆD€ÜAvÎìø,wµ0¬ØqÈŒëškÆ7¨©ÑŠ�y÷e ÍÉÀ`ue`âÒŒ@¼ À tjõ Pfizer RxPathways connects eligible patients to a range of assistance programs to help them access their Pfizer prescriptions. hŞìÑ1 0ð4°Æu\G` zè0«=i2ÚÒ\xˆñà! 0000135518 00000 n 0000026311 00000 n 0000129252 00000 n 0000026225 00000 n 0000007048 00000 n The most secure digital platform to get legally binding, electronically signed documents in just a few seconds.
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1110 0 obj <> endobj 0000093020 00000 n • Pfizer may verify the accuracy of the information I have provided and may ask for more financial and insurance information. 0000134428 00000 n Pfizer rxpathways application form. 0000077492 00000 n Filling out this form on the website does not complete a patient's enrollment. 0000029660 00000 n 0000082627 00000 n 0000108507 00000 n O”±od1?è®eÓàètPÍO!`ƒ3ĞI!•]Â|sƒRÁ-(–VÑ�`rJ*..¸d�Ò.®¡á¨R 0©P¬2‚@`lŠS*44‹G£ �’’’EGFj -æ¨N í 0000005237 00000 n 0000056788 00000 n %PDF-1.4 %âãÏÓ 0000005832 00000 n 0000025000 00000 n 0000013514 00000 n 0000001855 00000 n endstream endobj 887 0 obj <>/Metadata 68 0 R/Pages 67 0 R/StructTreeRoot 70 0 R/Type/Catalog/ViewerPreferences<>>> endobj 888 0 obj < 0000072275 00000 n
of this enrollment form. 0000004671 00000 n 0000082668 00000 n Group B [2 of 5] 0000061964 00000 n 0000000016 00000 n 0000007691 00000 n 0000002670 00000 n Pfizer RxPathways connects eligible patients to a range of assistance programs that offer insurance support, co-pay help,* and medicines for free or at a savings. Pfizer PAP Connect: Accessing your Pfizer prescribed medicine at your fingertips The Pfizer Patient Assistance Program (PAP) provides free medicines to eligible patients in need. This enrollment form is for patients who would like to apply to receive the Group A medicines found below for free. 0000009318 00000 n 0000124076 00000 n 0000098155 00000 n 0000134969 00000 n Pfizer RxPathways®Patient Assistance Program: Enrollment Form forGroup AMedicines Pfizer RxPathways is Pfizer’s prescription assistance program that provides eligible patients with access to their Pfizer medicines. trailer Pfizer RxPathways ® may be able to help. 0000005947 00000 n 0000006475 00000 n For more than 30 years, we’ve helped U.S. patients in need get access to their Pfizer medicines. 0000006060 00000 n 0000103372 00000 n 0000124035 00000 n 0000006089 00000 n 0000067099 00000 n 0000006390 00000 n 0000016205 00000 n 0000067140 00000 n
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