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region-content">     <div id="block-assist-content" class="block block-system block-system-main-block">     <article class="node node--type-page node--view-mode-full"> <div class="node__content">     <div class="layout layout--onecol"> <div class="layout__region layout__region--content">     <div class="block block-layout-builder block-field-blocknodepagebody">     <div class="text-formatted field field--name-body field--type-text-with-summary field--label-hidden field__item"></div>  </div>      <div class="block block-layout-builder block-extra-field-blocknodepagelinks">      </div>      <div class="block block-layout-builder block-field-blocknodepagefield-section">     <div class="field-sections">     <section class="intro" > <div class="wrapper">     <div class="text-formatted field field--name-field-content field--type-text-long field--label-hidden field__items"> <div class="field__item"><hr class="divider"><h2 class="text-align-center">Alnylam Assist<strong>®</strong> Online Start Form</h2><p>Help your patients get started on AMVUTTRA® (vutrisiran) by filling out the online Start Form together.</p><p>The purpose of this form is to permit Alnylam Assist<strong>®</strong> participants to receive additional information and support (“Patient Support”) from Alnylam Pharmaceuticals, Inc., its affiliates, representatives, agents, and contractors (“Alnylam”). Alnylam Assist<strong>®</strong> provides Patient Support to eligible patients who have been prescribed an Alnylam medicine. This includes: (1) providing reimbursement and financial support to eligible patients (such as investigating your patient's insurance coverage, confirming out-of-pocket costs, and reviewing eligibility for financial assistance); (2) working with you and your provider to fill your prescription; (3) providing you with disease and medication-related educational resources and communications; and (4) contacting you to participate in disease and medication-related market research panels or surveys. Your authorization in this form will relate to information and support with respect to any Alnylam medicine you have been prescribed or may be prescribed in the future.</p><p>PLEASE NOTE: Consent via electronic signature is mandatory for submission of the form. Forms must be submitted once started, as progress will not be saved. The online Start Form below should only be used if you and the patient are filling it out together currently. If not, please <a href="https://powerforms.docusign.net/ade037b0-7d33-4588-9096-e783fc1cdd98?env=na3&acct=8a23582c-123d-4ec3-9e29-8433ccb891d2&accountId=8a23582c-123d-4ec3-9e29-8433ccb891d2&recipientLang=en">click here</a> to go to DocuSign, where you can complete your portion and it will then be emailed to your patient for their portion.</p></div> </div>  </div> </section>      <div class="paragraph paragraph--type--webform paragraph--view-mode--default">     <div class="field field--name-field-webform field--type-webform field--label-hidden field__item">     <form class="webform-submission-form webform-submission-add-form webform-submission-amvuttra-hcp-start-form-form webform-submission-amvuttra-hcp-start-form-add-form webform-submission-amvuttra-hcp-start-form-paragraph-4530-form webform-submission-amvuttra-hcp-start-form-paragraph-4530-add-form start-form js-webform-disable-autosubmit js-webform-details-toggle webform-details-toggle" data-drupal-selector="webform-submission-amvuttra-hcp-start-form-paragraph-4530-add-form" action="/hcp/amvuttra/webform" method="post" id="webform-submission-amvuttra-hcp-start-form-paragraph-4530-add-form" accept-charset="UTF-8">         <div class="webform-progress">     <ul class="webform-progress-tracker progress-tracker" data-webform-progress-steps> <li data-webform-page="patient_information" title="Patient Information" class="progress-step is-active" aria-current="step"> <div class="progress-marker" data-webform-progress-step data-webform-progress-link data-text="1"></div> <div class="progress-text"> <div class="progress-title" data-webform-progress-link> <span class="visually-hidden" data-webform-progress-state>Current</span> Patient Information </div> </div> </li> <li data-webform-page="insurance_information" title="Insurance Information" class="progress-step"> <div class="progress-marker" data-webform-progress-step data-webform-progress-link data-text="2"></div> <div class="progress-text"> <div class="progress-title" data-webform-progress-link> <span class="visually-hidden" data-webform-progress-state></span> Insurance Information </div> </div> </li> <li data-webform-page="prescriber_information" title="Prescriber Information" class="progress-step"> <div class="progress-marker" data-webform-progress-step data-webform-progress-link data-text="3"></div> <div class="progress-text"> <div class="progress-title" data-webform-progress-link> <span class="visually-hidden" data-webform-progress-state></span> Prescriber Information </div> </div> </li> <li data-webform-page="givlaari_prescription" title="AMVUTTRA® (vutrisiran) Prescription" class="progress-step"> <div class="progress-marker" data-webform-progress-step data-webform-progress-link data-text="4"></div> <div class="progress-text"> <div class="progress-title" data-webform-progress-link> <span class="visually-hidden" data-webform-progress-state></span> AMVUTTRA® (vutrisiran) Prescription </div> </div> </li> </ul>  </div>      <div data-step="1" data-webform-key="patient_information" data-drupal-selector="edit-patient-information" id="edit-patient-information" class="js-form-wrapper form-wrapper">     <div class="top-inner-container js-form-wrapper form-wrapper" data-drupal-selector="edit-container-06" id="edit-container-06">     <div class="w-full mt-6 js-form-item form-item js-form-type-webform-markup form-type-webform-markup js-form-item-markup-01 form-item-markup-01 form-no-label" id="edit-markup-01">    <h2>Patient Information</h2>  </div>      <div class="w-full js-form-item form-item js-form-type-webform-markup form-type-webform-markup js-form-item-markup-02 form-item-markup-02 form-no-label" id="edit-markup-02">    <p class="my-0"><span class="requiredstep">* Indicates required field </span></p>  </div>  </div>     <hr class="br-top webform-horizontal-rule" data-drupal-selector="edit-horizontal-rule" id="edit-horizontal-rule" />      <div class="inner-container js-form-wrapper form-wrapper" data-drupal-selector="edit-inner-container" id="edit-inner-container">     <div class="md:w-2/5 js-form-item form-item js-form-type-textfield form-type-textfield js-form-item-first-name form-item-first-name">    <label for="edit-first-name" class="js-form-required form-required">First Name</label>      <input data-drupal-selector="edit-first-name" data-msg-required="First Name field is required." data-msg-maxlength="First Name field has a maximum length of 255." type="text" id="edit-first-name" name="first_name" value="" size="60" maxlength="255" class="form-text required" required="required" aria-required="true" />  </div>      <div class="md:w-1/6 js-form-item form-item js-form-type-textfield form-type-textfield js-form-item-middle-initial form-item-middle-initial">    <label for="edit-middle-initial">Middle Initial</label>      <input data-drupal-selector="edit-middle-initial" data-msg-maxlength="Middle Initial field has a maximum length of 255." type="text" id="edit-middle-initial" name="middle_initial" value="" size="60" maxlength="255" class="form-text" />  </div>      <div class="md:w-2/5 js-form-item form-item js-form-type-textfield form-type-textfield js-form-item-last-name form-item-last-name">    <label for="edit-last-name" class="js-form-required form-required">Last Name</label>      <input data-drupal-selector="edit-last-name" data-msg-required="Last Name field is required." data-msg-maxlength="Last Name field has a maximum length of 255." type="text" id="edit-last-name" name="last_name" value="" size="60" maxlength="255" class="form-text required" required="required" aria-required="true" />  </div>      <div class="md:w-1/4 js-form-item form-item js-form-type-date form-type-date js-form-item-dob form-item-dob">    <label for="edit-dob" class="js-form-required form-required">Date of Birth</label>      <input type="date" data-drupal-selector="edit-dob" data-msg-required="Date of Birth field is required." id="edit-dob" name="dob" value="" class="form-date required" required="required" aria-required="true" />  </div>      <div class="md:w-2/5 js-form-item form-item js-form-type-email form-type-email js-form-item-email-address form-item-email-address">    <label for="edit-email-address">Email Address</label>      <input data-drupal-selector="edit-email-address" data-msg-email="Email Address does not contain a valid email." data-msg-maxlength="Email Address field has a maximum length of 254." type="email" id="edit-email-address" name="email_address" value="" size="60" maxlength="254" class="form-email" />  </div>      <div style="clear:both;" class="js-form-item form-item js-form-type-webform-markup form-type-webform-markup js-form-item- form-item- form-no-label"> </div>     <fieldset class="md:w-1/3 radios--wrapper fieldgroup form-composite webform-composite-visible-title js-webform-type-radios webform-type-radios js-form-item form-item js-form-wrapper form-wrapper" data-drupal-selector="edit-language-translation" id="edit-language-translation--wrapper"> <legend id="edit-language-translation--wrapper-legend"> <span class="fieldset-legend">Language Translation?</span> </legend> <div class="fieldset-wrapper">    <div id="edit-language-translation" class="js-webform-radios webform-options-display-side-by-side form-radios">     <div class="js-form-item form-item js-form-type-radio form-type-radio js-form-item-language-translation form-item-language-translation">     <input class="md:w-1/3 form-radio" data-drupal-selector="edit-language-translation-yes" type="radio" id="edit-language-translation-yes" name="language_translation" value="Yes" />     <label for="edit-language-translation-yes" class="option"><span>Yes</span></label>  </div>      <div class="js-form-item form-item js-form-type-radio form-type-radio js-form-item-language-translation form-item-language-translation">     <input class="md:w-1/3 form-radio" data-drupal-selector="edit-language-translation-no" type="radio" id="edit-language-translation-no" name="language_translation" value="No" />     <label for="edit-language-translation-no" class="option"><span>No</span></label>  </div>  </div>  </div> </fieldset>      <div class="md:w-2/3 js-form-item form-item js-form-type-textfield form-type-textfield js-form-item-if-yes-please-indicate-language form-item-if-yes-please-indicate-language">    <label for="edit-if-yes-please-indicate-language">If yes, please indicate language:</label>      <input data-drupal-selector="edit-if-yes-please-indicate-language" data-msg-maxlength="If yes, please indicate language: field has a maximum length of 255." type="text" id="edit-if-yes-please-indicate-language" name="if_yes_please_indicate_language" value="" size="60" maxlength="255" class="form-text" />  </div>      <div class="md:w-4/5 js-form-item form-item js-form-type-textfield form-type-textfield js-form-item-street-address-line-1 form-item-street-address-line-1">    <label for="edit-street-address-line-1" class="js-form-required form-required">Street Address Line 1</label>      <input data-drupal-selector="edit-street-address-line-1" data-msg-required="Street Address Line 1 field is required." data-msg-maxlength="Street Address Line 1 field has a maximum length of 255." type="text" id="edit-street-address-line-1" name="street_address_line_1" value="" size="60" maxlength="255" class="form-text required" required="required" aria-required="true" />  </div>      <div class="md:w-4/5 js-form-item form-item js-form-type-textfield form-type-textfield js-form-item-street-address-line-2 form-item-street-address-line-2">    <label for="edit-street-address-line-2">Street Address Line 2 (Apartment, Suite, Unit, Etc)</label>      <input data-drupal-selector="edit-street-address-line-2" data-msg-maxlength="Street Address Line 2 (Apartment, Suite, Unit, Etc) field has a maximum length of 255." type="text" id="edit-street-address-line-2" name="street_address_line_2" value="" size="60" maxlength="255" class="form-text" />  </div>      <div class="md:w-4/5 js-form-item form-item js-form-type-textfield form-type-textfield js-form-item-city form-item-city">    <label for="edit-city" class="js-form-required form-required">City</label>      <input data-drupal-selector="edit-city" data-msg-required="City field is required." data-msg-maxlength="City field has a maximum length of 255." type="text" id="edit-city" name="city" value="" size="60" maxlength="255" class="form-text required" required="required" aria-required="true" />  </div>      <div class="md:w-1/3 js-form-item form-item js-form-type-select form-type-select js-form-item-state form-item-state">    <label for="edit-state" class="js-form-required form-required">State</label>     <select data-drupal-selector="edit-state" data-msg-required="State field is required." id="edit-state" name="state" class="form-select required" required="required" aria-required="true"><option value="" selected="selected">Please select</option><option value="Alabama">Alabama</option><option value="Alaska">Alaska</option><option value="Arizona">Arizona</option><option value="Arkansas">Arkansas</option><option value="California">California</option><option value="Colorado">Colorado</option><option value="Connecticut">Connecticut</option><option value="Delaware">Delaware</option><option value="District of Columbia">District of Columbia</option><option value="Florida">Florida</option><option value="Georgia">Georgia</option><option value="Hawaii">Hawaii</option><option value="Idaho">Idaho</option><option value="Illinois">Illinois</option><option value="Indiana">Indiana</option><option value="Iowa">Iowa</option><option value="Kansas">Kansas</option><option value="Kentucky">Kentucky</option><option value="Louisiana">Louisiana</option><option value="Maine">Maine</option><option value="Maryland">Maryland</option><option value="Massachusetts">Massachusetts</option><option value="Michigan">Michigan</option><option value="Minnesota">Minnesota</option><option value="Mississippi">Mississippi</option><option value="Missouri">Missouri</option><option value="Montana">Montana</option><option value="Nebraska">Nebraska</option><option value="Nevada">Nevada</option><option value="New Hampshire">New Hampshire</option><option value="New Jersey">New Jersey</option><option value="New Mexico">New Mexico</option><option value="New York">New York</option><option value="North Carolina">North Carolina</option><option value="North Dakota">North Dakota</option><option value="Ohio">Ohio</option><option value="Oklahoma">Oklahoma</option><option value="Oregon">Oregon</option><option value="Pennsylvania">Pennsylvania</option><option value="Rhode Island">Rhode Island</option><option value="South Carolina">South Carolina</option><option value="South Dakota">South Dakota</option><option value="Tennessee">Tennessee</option><option value="Texas">Texas</option><option value="Utah">Utah</option><option value="Vermont">Vermont</option><option value="Virginia">Virginia</option><option value="Washington">Washington</option><option value="West Virginia">West Virginia</option><option value="Wisconsin">Wisconsin</option><option value="Wyoming">Wyoming</option></select>  </div>      <div class="md:w-2/5 js-form-item form-item js-form-type-textfield form-type-textfield js-form-item-zip-code form-item-zip-code">    <label for="edit-zip-code" class="js-form-required form-required">ZIP</label>      <input data-inputmask-mask="99999[-9999]" class="js-webform-input-mask form-text required" pattern="^\d\d\d\d\d(-\d\d\d\d)?$" data-drupal-selector="edit-zip-code" data-msg-required="ZIP field is required." data-msg-maxlength="ZIP field has a maximum length of 255." data-msg-pattern="ZIP does not meet the requirements." type="text" id="edit-zip-code" name="zip_code" value="" size="60" maxlength="255" required="required" aria-required="true" />  </div>     <section class="md:w-1/3 js-form-item form-item js-form-wrapper form-wrapper webform-section" data-drupal-selector="edit-primary-phone-number-section" id="edit-primary-phone-number-section"> <h2 class="visually-hidden webform-section-title">Preferred Phone Number</h2> <div class="webform-section-wrapper">     <div class="js-form-item form-item js-form-type-textfield form-type-textfield js-form-item-primary-phone-number form-item-primary-phone-number">    <label for="edit-primary-phone-number" class="js-form-required form-required">Preferred Phone Number</label>      <input data-inputmask-mask="(999) 999-9999" class="js-webform-input-mask form-text required" pattern="^$\d\d\d$ \d\d\d-\d\d\d\d$" data-drupal-selector="edit-primary-phone-number" data-msg-required="Preferred Phone Number field is required." data-msg-maxlength="Preferred Phone Number field has a maximum length of 255." data-msg-pattern="Preferred Phone Number does not meet the requirements." type="text" id="edit-primary-phone-number" name="primary_phone_number" value="" size="60" maxlength="255" required="required" aria-required="true" />  </div>      <div class="js-form-item form-item js-form-type-checkbox form-type-checkbox js-form-item-okay-to-leave-voicemail form-item-okay-to-leave-voicemail">     <input data-drupal-selector="edit-okay-to-leave-voicemail" type="checkbox" id="edit-okay-to-leave-voicemail" name="okay_to_leave_voicemail" value="1" class="form-checkbox" />     <label for="edit-okay-to-leave-voicemail" class="option"><span class="inline-flex">Okay to leave voicemail on preferred phone number</span></label>  </div>  </div> </section>     <section class="md:w-1/3 js-form-item form-item js-form-wrapper form-wrapper webform-section" data-drupal-selector="edit-alternative-phone-number-section" id="edit-alternative-phone-number-section"> <h2 class="visually-hidden webform-section-title">Alternative Phone Number Section</h2> <div class="webform-section-wrapper">     <div class="js-form-item form-item js-form-type-textfield form-type-textfield js-form-item-preferred-phone-number form-item-preferred-phone-number">    <label for="edit-preferred-phone-number">Alternative Phone Number (if available)</label>      <input data-inputmask-mask="(999) 999-9999" class="js-webform-input-mask form-text" pattern="^$\d\d\d$ \d\d\d-\d\d\d\d$" data-drupal-selector="edit-preferred-phone-number" data-msg-maxlength="Alternative Phone Number (if available) field has a maximum length of 255." data-msg-pattern="Alternative Phone Number (if available) does not meet the requirements." type="text" id="edit-preferred-phone-number" name="preferred_phone_number" value="" size="60" maxlength="255" />  </div>      <div class="js-form-item form-item js-form-type-checkbox form-type-checkbox js-form-item-okay-to-leave-voicemail-2 form-item-okay-to-leave-voicemail-2">     <input data-drupal-selector="edit-okay-to-leave-voicemail-2" type="checkbox" id="edit-okay-to-leave-voicemail-2" name="okay_to_leave_voicemail_2" value="1" class="form-checkbox" />     <label for="edit-okay-to-leave-voicemail-2" class="option">Okay to leave voicemail on alternative phone number</label>  </div>  </div> </section>      <div class="w-full mt-12 js-form-item form-item js-form-type-webform-markup form-type-webform-markup js-form-item-markup-03 form-item-markup-03 form-no-label" id="edit-markup-03">    <h3>Caregiver Information (Optional)</h3>  </div>      <div class="md:w-2/5 js-form-item form-item js-form-type-textfield form-type-textfield js-form-item-caregiver-first-name form-item-caregiver-first-name">    <label for="edit-caregiver-first-name">Caregiver First Name</label>      <input data-drupal-selector="edit-caregiver-first-name" data-msg-maxlength="Caregiver First Name field has a maximum length of 255." type="text" id="edit-caregiver-first-name" name="caregiver_first_name" value="" size="60" maxlength="255" class="form-text" />  </div>      <div class="md:w-2/5 js-form-item form-item js-form-type-textfield form-type-textfield js-form-item-caregiver-last-name form-item-caregiver-last-name">    <label for="edit-caregiver-last-name">Caregiver Last Name</label>      <input data-drupal-selector="edit-caregiver-last-name" data-msg-maxlength="Caregiver Last Name field has a maximum length of 255." type="text" id="edit-caregiver-last-name" name="caregiver_last_name" value="" size="60" maxlength="255" class="form-text" />  </div>      <div class="md:w-2/5 js-form-item form-item js-form-type-email form-type-email js-form-item-caregiver-email form-item-caregiver-email">    <label for="edit-caregiver-email">Caregiver Email Address</label>      <input data-drupal-selector="edit-caregiver-email" data-msg-email="Caregiver Email Address does not contain a valid email." data-msg-maxlength="Caregiver Email Address field has a maximum length of 254." type="email" id="edit-caregiver-email" name="caregiver_email" value="" size="60" maxlength="254" class="form-email" />  </div>      <div class="md:w-2/5 js-form-item form-item js-form-type-textfield form-type-textfield js-form-item-relationship-to-patient form-item-relationship-to-patient">    <label for="edit-relationship-to-patient">Caregiver Relationship to Patient</label>      <input data-drupal-selector="edit-relationship-to-patient" data-msg-maxlength="Caregiver Relationship to Patient field has a maximum length of 255." type="text" id="edit-relationship-to-patient" name="relationship_to_patient" value="" size="60" maxlength="255" class="form-text" />  </div>      <div class="md:w-2/5 js-form-item form-item js-form-type-textfield form-type-textfield js-form-item-caregiver-phone-number form-item-caregiver-phone-number">    <label for="edit-caregiver-phone-number">Caregiver Phone Number</label>      <input data-inputmask-mask="(999) 999-9999" class="js-webform-input-mask form-text" pattern="^$\d\d\d$ \d\d\d-\d\d\d\d$" data-drupal-selector="edit-caregiver-phone-number" data-msg-maxlength="Caregiver Phone Number field has a maximum length of 255." data-msg-pattern="Caregiver Phone Number does not meet the requirements." type="text" id="edit-caregiver-phone-number" name="caregiver_phone_number" value="" size="60" maxlength="255" />  </div>      <div class="md:w-2/5 w-full js-form-item form-item js-form-type-checkbox form-type-checkbox js-form-item-caregiver-okay-to-leave-voicemail form-item-caregiver-okay-to-leave-voicemail">     <input data-drupal-selector="edit-caregiver-okay-to-leave-voicemail" type="checkbox" id="edit-caregiver-okay-to-leave-voicemail" name="caregiver_okay_to_leave_voicemail" value="1" class="form-checkbox" />     <label for="edit-caregiver-okay-to-leave-voicemail" class="option">Okay to leave voicemail</label>  </div>      <div style="clear:both;" class="js-form-item form-item js-form-type-webform-markup form-type-webform-markup js-form-item- form-item- form-no-label"> </div>      <div class="w-full self-start js-form-item form-item js-form-type-processed-text form-type-processed-text js-form-item- form-item- form-no-label" id="edit-processed-text-authorization"> <p><strong>I have read and agree to the Patient Authorization and Support Program Authorization below</strong></p> </div>      <div class="md:w-1/2 with-astric js-form-item form-item js-form-type-textfield form-type-textfield js-form-item-patient-or-authorized-patient-representative-name form-item-patient-or-authorized-patient-representative-name">    <label for="edit-patient-or-authorized-patient-representative-name" class="js-form-required form-required">Patient/Legal Representative Name</label>      <input data-drupal-selector="edit-patient-or-authorized-patient-representative-name" data-msg-required="Patient/Legal Representative Name field is required." data-msg-maxlength="Patient/Legal Representative Name field has a maximum length of 255." type="text" id="edit-patient-or-authorized-patient-representative-name" name="patient_or_authorized_patient_representative_name" value="" size="60" maxlength="255" class="form-text required" required="required" aria-required="true" />  </div>      <div class="md:w-1/2 js-form-item form-item js-form-type-textfield form-type-textfield js-form-item-authorize-relationship-to-patient form-item-authorize-relationship-to-patient">    <label for="edit-authorize-relationship-to-patient">Relationship to Patient</label>      <input data-drupal-selector="edit-authorize-relationship-to-patient" data-msg-maxlength="Relationship to Patient field has a maximum length of 255." type="text" id="edit-authorize-relationship-to-patient" name="authorize_relationship_to_patient" value="" size="60" maxlength="255" class="form-text" />  </div>      <div class="md:w-1/3 js-form-item form-item js-form-type-date form-type-date js-form-item-authorize-date form-item-authorize-date">    <label for="edit-authorize-date" class="js-form-required form-required">Date</label>      <input type="date" data-drupal-selector="edit-authorize-date" data-msg-required="Date field is required." id="edit-authorize-date" name="authorize_date" value="2024-11-14" class="form-date required" required="required" aria-required="true" />  </div>  </div>  </div>      <div id="edit-processed-text-02" class="js-form-item form-item js-form-type-processed-text form-type-processed-text js-form-item- form-item- form-no-label"> <script> document.addEventListener('DOMContentLoaded', function() { document.querySelector('[data-webform-page="patient_information"] .progress-text').style.maxWidth = '130px'; }); </script> </div>      <div style="clear:both;" class="js-form-item form-item js-form-type-webform-markup form-type-webform-markup js-form-item- form-item- form-no-label"> </div>      <input autocomplete="off" data-drupal-selector="form-3ltypkmdjauzyv7n5-ymwugsvpyynaxjm2ukovtwjii" type="hidden" name="form_build_id" value="form-3ltyPKmDjauZYv7N5-yMWuGsvpyynAxJm2uKoVtwJII" />      <input data-drupal-selector="edit-webform-submission-amvuttra-hcp-start-form-paragraph-4530-add-form" type="hidden" name="form_id" value="webform_submission_amvuttra_hcp_start_form_paragraph_4530_add_form" />      <div data-drupal-selector="edit-actions" class="form-actions js-form-wrapper form-wrapper" id="edit-actions">        <input class="webform-button--next button js-form-submit form-submit" data-drupal-selector="edit-wizard-next" type="submit" id="edit-wizard-next" name="op" value="Continue" />   </div>   </form>  </div>  </div>      <section > <div class="wrapper">     <div class="text-formatted field field--name-field-content field--type-text-long field--label-hidden field__items"> <div class="field__item"><h3 style="display:none;" data-show-on-step-1="">Authorization to Share Protected Health Information</h3><p style="display:none;" data-show-on-step-1="">I authorize my healthcare providers, including my physicians and pharmacies (“My Providers”) and my health insurance plan (“My Plan”) to share my medical information (such as information about my diagnosis, prescriptions, and treatment) and my insurance information (“My Information”) with Alnylam so that Alnylam can provide Patient Support. I authorize My Providers to use My Information to provide me with certain offerings related to my treatment and any Alnylam medicine My Providers may prescribe for me at any time. I understand that my pharmacy will receive payment from Alnylam for disclosing My Information to Alnylam. I understand that once My Information has been disclosed, federal privacy laws may no longer protect the information. However, I understand that Alnylam agrees to protect My Information by using and disclosing it only for purposes described in this Authorization or as required by law. I understand that I may refuse to sign this Authorization, and that my treatment, insurance enrollment, and eligibility for insurance benefits are not conditioned upon signing this Authorization.</p><p style="display:none;" data-show-on-step-1="">I also understand, however, that refusing to sign this Authorization means that I may not participate in Alnylam Assist® and may not be able to take advantage of other offerings by Alnylam. I may cancel or revoke this Authorization at any time by mailing a letter to Privacy Officer at Alnylam, Attn: Legal Department, 675 West Kendall Street, Cambridge, MA 02142 or by sending an email to privacy@alnylam.com. I understand that if I revoke this Authorization, My Providers and Alnylam will stop using and sharing My Information under this Authorization, but my revocation will not affect uses and disclosures of My Information prior to my revocation in reliance upon this Authorization. This Authorization expires ten (10) years from the date signed on page 1, or earlier if required by state or local law, unless I revoke it before then. I understand that I may receive a copy of this Authorization. For information about how your personal data are processed as a part of our program, please visit <a class="js-open-corp" href="https://www.alnylampolicies.com/privacy">www.alnylampolicies.com/privacy</a>.</p><h3 style="display:none;" data-show-on-step-1="">Authorization for Alnylam Assist® and Communications</h3><p style="display:none;padding-bottom:36px;" data-show-on-step-1="">I confirm I would like to enroll in the Alnylam Assist® program and authorize Alnylam to provide me with Patient Support. I understand that Alnylam Assist® is an optional program. I agree that Alnylam may use My Information and share it with My Providers or My Plan in connection with providing the Patient Support, administering the Alnylam Assist® program, or as otherwise required by Alnylam to meet its legal obligations. For example, Alnylam may communicate with me (such as by mail, phone, email, and/or text message) or my caregiver, use My Information to tailor the Alnylam Assist®–related communications to my needs, and share information with My Providers about dispensing Alnylam medicine to me. I understand that Alnylam may de-identify My Information, combine it with information about other patients, and use the resulting information for Alnylam’s business purposes. 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