Medication consent

Informed Consent for Treatment with Orencia (abatacept)

Informed consent for treatment with Orencia.

About this form

Orencia (abatacept) is approved for moderate-to-severe rheumatoid arthritis, psoriatic arthritis, and juvenile idiopathic arthritis. It works by selectively modulating T-cell activation, a key driver of autoimmune inflammation.

!Increased risk of serious infections; do not start with active infection.
!Avoid combining with TNF blockers due to additive infection risk.
!TB testing recommended prior to therapy.
!COPD patients may experience worsening respiratory symptoms.
!Live vaccines should be avoided during therapy and for 3 months after.

Progress

Patient information

Patient name *Date of birth *

Benefits

I understand that the potential benefits of this treatment include: *

Reduces inflammation and joint damage in RA, PsA, and JIA.Generally well-tolerated long-term.

Common side effects

I have been informed of the most common side effects, which include: *

HeadacheUpper respiratory tract infectionsSore throat / nasopharyngitisNausea

Acknowledgements

I have had the opportunity to discuss this treatment with my physician. *

Yes — I have had this opportunity

All of my questions have been answered to my satisfaction. *

Yes — my questions have been answered

I understand my financial responsibility for this treatment. *

Yes — I understand

Any additional questions or notes for our team

Sign & submit

Patient signature *Sign with your finger, mouse or trackpad in the box below.

Sign here with your finger, mouse or trackpad

Your signature will appear on the exported PDF.

Date signed *Email address (so we can confirm receipt) *

Acknowledgement. I certify that I have read and understood this consent form, that I have had the opportunity to discuss it with my physician, and that I agree to receive treatment with Orencia (abatacept).

Submitting transmits this form securely to our office. Export to PDF works even with partial answers — useful if you want a printed copy to bring in. For urgent medical issues, please call our office or 911.

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