Program Contact Info / Application Submission
Program	Shire US Patient Assistance Program
Company	ShireCarb
Program Requirements
Details	Insurance card required Drivers license required Proof of Income required Copy of most recent tax return such as 1040, 1099 required as proof of income Letter from Doctor stating zero income required as proof of income Form 4506T (If taxes were not filed) required as proof of income Most recent check/check stub copy required as proof of income Benefits statement for Social Security, Unemployment, Veterans Benefits, Pension/Retirement required as proof of income
Delivery of Medication
Delivery Options	Can be delivered directly to the patient Can NOT be delivered directly to the doctor Shipped as a voucher card
Application Process
New Applications	New applications accepted Patients can apply directly to the program Doctors can apply directly to the program Advocates can apply directly to the program Can NOT apply for a new application via phone Can NOT apply for a new application via fax Can apply for a new application via mail
Refills	Refills accepted Patients can apply for refills Doctors can apply for refills Advocates can apply for refills
Re-Applications	Re-Applications accepted