For TB006 EAP patients or caregivers with medical concerns:
Please contact your TB006 provider directly regarding any medical questions.

Submitting Personal Health Information (PHI):
PHI includes any information that can identify a patient and relates to their health, such as:

• Name, date of birth, or contact information

• Medical conditions, diagnoses, or treatment details

• Medications, lab results, or medical records

If you need to submit PHI, you must complete the HIPAA release form below. This authorizes the disclosure of your health information. After submitting the HIPAA form, you will be redirected to a second page where you can fill out the inquiry form and upload documents.

General Information Requests (No PHI Required):
If you are only requesting general program information (such as study eligibility, program logistics, or how to participate), a HIPAA form is not required. Click here to submit general information.
Do not include any patient names, medical records, or other sensitive information in this form.