Requests must be submitted by the treating physician or a designated requesting healthcare provider. Patient eligibility will be determined by Emergent in accordance with established policies and procedures. Emergent’s processing of this application does not guarantee that access to the Product will be provided.

Release of the product is subject to the acceptance of Emergent’s terms of sale, and the requesting country must have regulatory and market access framework compatible with conditions for supply of product under Named Patient Requests.

Fields with an asterisk (*) are mandatory.