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Dalvance® (dalbavancin)

Step 1

The below checklist is designed to streamline the referral process. It is not required to submit a referral.

*for reference, not required

Step 2

Complete and submit the therapy-specific Order Form.

–or–

Patient Care

Our standing treatment orders and protocols are located below for your review.

Completed order forms and supporting clinical documentation can be faxed to (833) 786-0025 or uploaded to our secured portal.