{"id":10236,"date":"2019-02-21T19:24:08","date_gmt":"2019-02-22T03:24:08","guid":{"rendered":"https:\/\/ameripharmainfusioncenter.com\/?page_id=10236"},"modified":"2025-12-15T07:26:09","modified_gmt":"2025-12-15T15:26:09","slug":"enrollment-forms","status":"publish","type":"page","link":"https:\/\/ameripharmainfusioncenter.com\/vi\/enrollment-forms\/","title":{"rendered":"Bi\u1ec3u m\u1eabu ghi danh"},"content":{"rendered":"<div  id=\"pdf-forms-acdc3fdec97d61d91a6152f266654172\" style=\"\" class=\"pdfForms\">\n    <div class=\"container\">\n        <div class=\"block-wrap ct_pdfForms\">\n        <h2 class=\"pdfForms_heading\"><\/h2>\n            <div class=\"pdfForms_inner col2\">\n                                                                                        <div class=\"pdfForms_inner_col_box\">\n                                <h3>B\u1ec7nh Crohn \/ Vi\u00eam lo\u00e9t \u0111\u1ea1i tr\u00e0ng<\/h3>\n                                <ul>\n                                                                                                                <li>\n                                            <a href=\"https:\/\/ameripharmainfusioncenter.com\/wp-content\/uploads\/2024\/11\/cduc-rf-crohns-disease-ulcerative-colitis-referral-form.pdf\" target=\"_blank\" > \n                                                <img decoding=\"async\" src=\"https:\/\/ameripharmainfusioncenter.com\/wp-content\/themes\/ct-theme\/assets\/img\/pdf-icon.png\" alt=\"PDF\" \/>\n                                                T\u1ea3i xu\u1ed1ng m\u1eabu gi\u1edbi thi\u1ec7u\n                                            <\/a>\n                                        <\/li>\n                                                                    <\/ul>\n                            <\/div>\n                                                                                                <div class=\"pdfForms_inner_col_box\">\n                                <h3> Globulin mi\u1ec5n d\u1ecbch ti\u00eam t\u0129nh m\u1ea1ch<\/h3>\n                                <ul>\n                                                                                                                <li>\n                                            <a href=\"https:\/\/ameripharmainfusioncenter.com\/wp-content\/uploads\/2024\/10\/ivig-rf-intravenous-immune-globulin-referral-form.pdf\" target=\"_blank\" > \n                                                <img decoding=\"async\" src=\"https:\/\/ameripharmainfusioncenter.com\/wp-content\/themes\/ct-theme\/assets\/img\/pdf-icon.png\" alt=\"PDF\" \/>\n                                                T\u1ea3i xu\u1ed1ng m\u1eabu gi\u1edbi thi\u1ec7u\n                                            <\/a>\n                                        <\/li>\n                                                                    <\/ul>\n                            <\/div>\n                                                                                                <div class=\"pdfForms_inner_col_box\">\n                                <h3>Globulin mi\u1ec5n d\u1ecbch d\u01b0\u1edbi da<\/h3>\n                                <ul>\n                                                                            <li>\n                                            <a href=\"https:\/\/ameripharmainfusioncenter.com\/wp-content\/uploads\/2024\/11\/IVIG-SubQ-Order-Form.pdf\" target=\"_blank\" >\n                                            <img decoding=\"async\" src=\"https:\/\/ameripharmainfusioncenter.com\/wp-content\/themes\/ct-theme\/assets\/img\/pdf-icon.png\" alt=\"PDF\" \/>\n                                            T\u1ea3i xu\u1ed1ng m\u1eabu \u0111\u01a1n \u0111\u1eb7t h\u00e0ng\n                                            <\/a>\n                                        <\/li>\n                                                                                                        <\/ul>\n                            <\/div>\n                                                                                                <div class=\"pdfForms_inner_col_box\">\n                                <h3>B\u1ec7nh m\u00e1u kh\u00f3 \u0111\u00f4ng \/ R\u1ed1i lo\u1ea1n ch\u1ea3y m\u00e1u<\/h3>\n                                <ul>\n                                                                                                                <li>\n                                            <a href=\"https:\/\/ameripharmainfusioncenter.com\/wp-content\/uploads\/2024\/10\/Updated_05.04.2024-Hemophilia-Referral-form.pdf\" target=\"_blank\" > \n                                                <img decoding=\"async\" src=\"https:\/\/ameripharmainfusioncenter.com\/wp-content\/themes\/ct-theme\/assets\/img\/pdf-icon.png\" alt=\"PDF\" \/>\n                                                T\u1ea3i xu\u1ed1ng m\u1eabu gi\u1edbi thi\u1ec7u\n                                            <\/a>\n                                        <\/li>\n                                                                    <\/ul>\n                            <\/div>\n                                                                                                <div class=\"pdfForms_inner_col_box\">\n                                <h3> Ung th\u01b0 h\u1ecdc<\/h3>\n                                <ul>\n                                                                            <li>\n                                            <a href=\"https:\/\/ameripharmainfusioncenter.com\/wp-content\/uploads\/2024\/10\/ONCOLOGY-REFERRAL-FORM.pdf\" target=\"_blank\" >\n                                            <img decoding=\"async\" src=\"https:\/\/ameripharmainfusioncenter.com\/wp-content\/themes\/ct-theme\/assets\/img\/pdf-icon.png\" alt=\"PDF\" \/>\n                                            T\u1ea3i xu\u1ed1ng m\u1eabu \u0111\u01a1n \u0111\u1eb7t h\u00e0ng\n                                            <\/a>\n                                        <\/li>\n                                                                                                        <\/ul>\n                            <\/div>\n                                                                                                <div class=\"pdfForms_inner_col_box\">\n                                <h3>Truy\u1ec1n d\u1ecbch t\u0129nh m\u1ea1ch cho b\u1ec7nh \u0111a x\u01a1 c\u1ee9ng<\/h3>\n                                <ul>\n                                                                            <li>\n                                            <a href=\"https:\/\/ameripharmainfusioncenter.com\/wp-content\/uploads\/2024\/10\/multiple-sclerosis-enrollment-form.pdf\" target=\"_blank\" >\n                                            <img decoding=\"async\" src=\"https:\/\/ameripharmainfusioncenter.com\/wp-content\/themes\/ct-theme\/assets\/img\/pdf-icon.png\" alt=\"PDF\" \/>\n                                            T\u1ea3i xu\u1ed1ng m\u1eabu \u0111\u01a1n \u0111\u1eb7t h\u00e0ng\n                                            <\/a>\n                                        <\/li>\n                                                                                                        <\/ul>\n                            <\/div>\n                                                                                                <div class=\"pdfForms_inner_col_box\">\n                                <h3>Li\u1ec7u ph\u00e1p truy\u1ec1n d\u1ecbch<\/h3>\n                                <ul>\n                                                                                                                <li>\n                                            <a href=\"https:\/\/ameripharmainfusioncenter.com\/wp-content\/uploads\/2024\/10\/inft-rf-infusion-therapy-referral-form.pdf\" target=\"_blank\" > \n                                                <img decoding=\"async\" src=\"https:\/\/ameripharmainfusioncenter.com\/wp-content\/themes\/ct-theme\/assets\/img\/pdf-icon.png\" alt=\"PDF\" \/>\n                                                T\u1ea3i xu\u1ed1ng m\u1eabu gi\u1edbi thi\u1ec7u\n                                            <\/a>\n                                        <\/li>\n                                                                    <\/ul>\n                            <\/div>\n                                                                                                <div class=\"pdfForms_inner_col_box\">\n                                <h3>B\u1ec7nh th\u1ea5p kh\u1edbp<\/h3>\n                                <ul>\n                                                                                                                <li>\n                                            <a href=\"https:\/\/ameripharmainfusioncenter.com\/wp-content\/uploads\/2024\/10\/RHEUMATOLOGY-REFERRAL-FORM.pdf\" target=\"_blank\" > \n                                                <img decoding=\"async\" src=\"https:\/\/ameripharmainfusioncenter.com\/wp-content\/themes\/ct-theme\/assets\/img\/pdf-icon.png\" alt=\"PDF\" \/>\n                                                T\u1ea3i xu\u1ed1ng m\u1eabu gi\u1edbi thi\u1ec7u\n                                            <\/a>\n                                        <\/li>\n                                                                    <\/ul>\n                            <\/div>\n                                                                                                <div class=\"pdfForms_inner_col_box\">\n                                <h3>B\u1ec7nh x\u01a1 nang<\/h3>\n                                <ul>\n                                                                            <li>\n                                            <a href=\"https:\/\/ameripharmainfusioncenter.com\/wp-content\/uploads\/2024\/10\/cystic_fibrosis_referral_form.pdf\" target=\"_blank\" >\n                                            <img decoding=\"async\" src=\"https:\/\/ameripharmainfusioncenter.com\/wp-content\/themes\/ct-theme\/assets\/img\/pdf-icon.png\" alt=\"PDF\" \/>\n                                            T\u1ea3i xu\u1ed1ng m\u1eabu \u0111\u01a1n \u0111\u1eb7t h\u00e0ng\n                                            <\/a>\n                                        <\/li>\n                                                                                                        <\/ul>\n                            <\/div>\n                                                                        <\/div>\n        <\/div>\n    <\/div>\n<\/div>\n\n\n\n<div class=\"wp-block-columns container is-layout-flex wp-container-core-columns-is-layout-9d6595d7 wp-block-columns-is-layout-flex\">\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\">\n<div style=\"height:40px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<div class=\"wp-block-media-text is-stacked-on-mobile oc-flexbox ef-flexbox roundedimg\"><figure class=\"wp-block-media-text__media\"><img loading=\"lazy\" decoding=\"async\" width=\"600\" height=\"337\" src=\"https:\/\/ameripharmainfusioncenter.com\/wp-content\/uploads\/2019\/04\/ameripharma-enrollment-1.jpg\" alt=\"AmeriPharma enrollment and consultation\" class=\"wp-image-11094 size-full\" srcset=\"https:\/\/ameripharmainfusioncenter.com\/wp-content\/uploads\/2019\/04\/ameripharma-enrollment-1.jpg 600w, https:\/\/ameripharmainfusioncenter.com\/wp-content\/uploads\/2019\/04\/ameripharma-enrollment-1-300x169.jpg 300w\" sizes=\"auto, (max-width: 600px) 100vw, 600px\" \/><\/figure><div class=\"wp-block-media-text__content\">\n<p class=\"has-large-font-size\"><strong>\u0110\u1ec3 tu\u00e2n th\u1ee7 c\u00e1c ti\u00eau chu\u1ea9n v\u00e0 quy \u0111\u1ecbnh hi\u1ec7n h\u00e0nh, ch\u00fang t\u00f4i ch\u1ec9 c\u00f3 th\u1ec3 ch\u1ea5p nh\u1eadn \u0111\u01a1n thu\u1ed1c \u0111\u01b0\u1ee3c g\u1eedi qua fax t\u1eeb c\u00e1c b\u00e1c s\u0129 k\u00ea \u0111\u01a1n trong khi b\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 n\u1ed9p \u0111\u01a1n thu\u1ed1c g\u1ed1c.<\/strong><\/p>\n<\/div><\/div>\n\n\n\n<div style=\"height:80px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n<\/div>\n<\/div>\n\n\n\n<p><\/p>","protected":false},"excerpt":{"rendered":"<p>\u0110\u1ec3 tu\u00e2n th\u1ee7 c\u00e1c ti\u00eau chu\u1ea9n v\u00e0 quy \u0111\u1ecbnh hi\u1ec7n h\u00e0nh, ch\u00fang t\u00f4i ch\u1ec9 c\u00f3 th\u1ec3 ch\u1ea5p nh\u1eadn \u0111\u01a1n thu\u1ed1c \u0111\u01b0\u1ee3c g\u1eedi qua fax t\u1eeb c\u00e1c b\u00e1c s\u0129 k\u00ea \u0111\u01a1n trong khi b\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 n\u1ed9p \u0111\u01a1n thu\u1ed1c g\u1ed1c.<\/p>","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":true,"inline_featured_image":false,"_uag_custom_page_level_css":"","footnotes":""},"class_list":["post-10236","page","type-page","status-publish","hentry"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.4 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Enrollment Form | AmeriPharma Infusion Center<\/title>\n<meta name=\"description\" content=\"Download and complete the AmeriPharma Infusion Center enrollment forms and submit to us via fax from a doctor&#039;s office or in-person.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/ameripharmainfusioncenter.com\/vi\/enrollment-forms\/\" \/>\n<meta property=\"og:locale\" content=\"vi_VN\" \/>\n<meta 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original prescription","_links":{"self":[{"href":"https:\/\/ameripharmainfusioncenter.com\/vi\/wp-json\/wp\/v2\/pages\/10236","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/ameripharmainfusioncenter.com\/vi\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/ameripharmainfusioncenter.com\/vi\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/ameripharmainfusioncenter.com\/vi\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/ameripharmainfusioncenter.com\/vi\/wp-json\/wp\/v2\/comments?post=10236"}],"version-history":[{"count":0,"href":"https:\/\/ameripharmainfusioncenter.com\/vi\/wp-json\/wp\/v2\/pages\/10236\/revisions"}],"wp:attachment":[{"href":"https:\/\/ameripharmainfusioncenter.com\/vi\/wp-json\/wp\/v2\/media?parent=10236"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}