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Informed Consent For Actemra Un-Licensed Iindication Vers 2.0
Informed Consent For Actemra Un-Licensed Iindication Vers 2.0
The purchase order to PT Tempo for product _____________, ____ vials (as per
Purchase Order number _________ as per-attached) is intended for the treatment of
hospitalized COVID-19 patients.
Patient Initial(s):
Treating Physician(s):
Name
Title
Date