Patient Pre-Enrollment
Instructions
All female patients taking ambrisentan must be enrolled in the PS-Ambrisentan REMS. A doctor enrolled in the PS-Ambrisentan REMS must complete the enrollment, but the patient may start the enrollment with the Patient Pre-Enrollment process. This will save the patient and the doctor time in completing the enrollment process.

1
Patient Information - When pre-enrolling, the patient will enter information such as name, address, phone number, date of birth, and email address.

2
Alternate Contact - The patient may enter information about another person the REMS Coordinating Center can contact if the patient cannot be reached. Parent/Guardian contact information is required for a patient that is under the age of 18 years old.

3
Account Setup - Create a username and password for your program account

4
Agreement - You must agree to understanding the PS-Ambrisentan REMS requirements for female patients and sign or enter your name.

5
Complete Pre-Enrollment - When the Pre-Enrollment is complete, a "Pre-Enrollment Confirmation Number" will be presented that can be provided to an PS-Ambrisentan REMS enrolled doctor to complete the enrollment.