Medical Information Requests Please enable JavaScript in your browser to complete this form.Preferred Response MethodEmailPhoneFax Product *GenVisc*850Trivisc*Name *FirstLastZip Code *Professional DesignationMDPANPRPhRNOtherInstitutionEmail *Confirm Email *Phone *FaxMedical Information Request *Please note that any requests for published literature or journal reprints may fall under the physician payment reporting provisions of Patient Protection and Affordable Care Act of 2010 (the “Sunshine Provisions”) or other applicable state laws. These provisions require that all applicable manufacturers, including OrthogenRx, track and report to the Centers for Medicare and Medicaid Services (CMS) or applicable state agency, all transfers of value to U.S. Physicians, specifically including the value of journal reprints. This communication is not intended to comply with HIPAA requirements. Please do not add any patient identifying or patient specific information. Required *I confirm I am a US-based medical and scientific professionalSubmit