Referral Forms

Referral Forms

For providers referring patients to the Rheumatology Associates Infusion Center, please fill out the downloadable referral form for the specific infusion therapy being prescribed.

Ensure that all sections of the form are fully completed and that the requested information is spelled out at the bottom of the form before faxing it to our Billing Office at 410-494-1066. Once received, our team will initiate the prior authorization process.

After the patient’s medication has been approved by their insurance provider, we will:

  • Contact the patient directly to schedule their infusion appointment.
  • Reach out to your office for a formal order and any additional instructions needed.

We appreciate your partnership in delivering timely, coordinated infusion care.

Actemra (Tocilizumab)

Actemra (Tocilizumab)

Avsola (infliximab-axxq)

Avsola (infliximab-axxq)

Benlysta (belimumab)

Benlysta (belimumab)

Cimzia (certolizumab pegol)

Cimzia (certolizumab pegol)

Cosentyx IV (secukinumab)

Cosentyx IV (secukinumab)

Entyvio (vedolizumab)

Entyvio (vedolizumab)

Evenity (romosozumab-aqqg)

Evenity (romosozumab-aqqg)

Ilumya (tildrakizumab-asmn)

Ilumya (tildrakizumab-asmn)

Krystexxa (pegloticase)

Krystexxa (pegloticase)

Ocrevus (ocrelizumab)

Ocrevus (ocrelizumab)

Orencia (abacept)

Orencia (abacept)

Prolia (denosumab)

Prolia (denosumab)

Remicade (infliximab)

Remicade (infliximab)

Rituxan (Rituximab)

Rituxan (Rituximab)

Ruxience (rituximab-pvvr)

Ruxience (rituximab-pvvr)

Saphnelo (anifrolumab-fnia)

Saphnelo (anifrolumab-fnia)

Simponi Aria (Golimumab)

Simponi Aria (Golimumab)

Skyrizi IV (risankizumab-rzaa)

Skyrizi IV (risankizumab-rzaa)

Stelara IV (Ustekinumab)

Stelara IV (Ustekinumab)

Stelara SQ (Ustekinumab)

Stelara SQ (Ustekinumab)

Truxima (rituximab-abbs)

Truxima (rituximab-abbs)

Zolendronic Acid/Reclast

Zolendronic Acid/Reclast